MEDICARE: JENNIFER JOHNSON

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	174200000X	Meals Provider
2	374U00000X	Home Health Aide	00623941	NY
3	376J00000X	Homemaker
4	332U00000X	Home Delivered Meals

General Provider Information

NPI Number	:	1649169657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER JOHNSON

Provider Business Mailing Address
First Line	:	500 8TH AVENUE, FRNT 3
Second Line	:	#1630
City	:	MANHATTAN
State	:	NY
Zip	:	10018
Country	:	US
Telephone Number	:	631-579-4112
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 HILLTOP LN
Second Line	:
City	:	WHEATLEY HEIGHTS
State	:	NY
Zip	:	11798-1303
Country	:	US
Telephone Number	:	631-579-4112
Fax Number	:

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

Provider Enumeration Date	:	07/02/2025
Last Update Date	:	07/02/2025

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Directions to “ JENNIFER JOHNSON ” Practice Location

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