MEDICARE: JONATHAN DEJESUS RRT

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	227900000X	Registered Respiratory Therapist
2	227900000X	Registered Respiratory Therapist	43ZA00638000	NJ

General Provider Information

NPI Number	:	1700576238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN DEJESUS RRT

Provider Business Mailing Address
First Line	:	3 LAVISTER DR
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-2641
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 THE AMERICAN RD
Second Line	:
City	:	MORRIS PLAINS
State	:	NJ
Zip	:	07950-2449
Country	:	US
Telephone Number	:	800-287-0644
Fax Number	:

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

Provider Enumeration Date	:	05/09/2023
Last Update Date	:	05/09/2023

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Directions to “ JONATHAN DEJESUS RRT” Practice Location

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