MEDICARE: JENNIFER JEZEQUEL

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	2251P0200X	Pediatric Physical Therapist

General Provider Information

NPI Number	:	1487277158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER JEZEQUEL

Provider Business Mailing Address
First Line	:	510 E 73RD ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-4010
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 E 73RD ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-4010
Country	:	US
Telephone Number	:	212-606-1215
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2020
Last Update Date	:	04/09/2021

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Directions to “ JENNIFER JEZEQUEL ” Practice Location

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