MEDICARE: HO-YEONG JONG

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	101YP1600X	Pastoral Counselor

General Provider Information

NPI Number	:	1619185782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HO-YEONG JONG

Provider Business Mailing Address
First Line	:	18 ASHWOOD CT
Second Line	:
City	:	EAST NORTHPORT
State	:	NY
Zip	:	11731-2321
Country	:	US
Telephone Number	:	917-254-1300
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 ASHWOOD CT
Second Line	:
City	:	EAST NORTHPORT
State	:	NY
Zip	:	11731-2321
Country	:	US
Telephone Number	:	917-254-1300
Fax Number	:

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

Provider Enumeration Date	:	05/20/2007
Last Update Date	:	07/08/2007

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Directions to “ HO-YEONG JONG ” Practice Location

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