MEDICARE: JLP MEDICINE, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	257892	NY

General Provider Information

NPI Number	:	1407158470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JLP MEDICINE, PC

Provider Business Mailing Address
First Line	:	10 TIMOTHY LN
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-4560
Country	:	US
Telephone Number	:	732-306-4935
Fax Number	:	732-238-7115

Provider Business Practice Location Address
First Line	:	2035 RALPH AVE
Second Line	:	SUITE A-4
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5300
Country	:	US
Telephone Number	:	732-306-4935
Fax Number	:	732-238-7115

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JODI PESKA MOSSERI
Credential	:	D.O.
Telephone Number	:	732-306-4935

Provider Enumeration Date	:	11/24/2010
Last Update Date	:	11/24/2010

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