MEDICARE: DR. JOAN JONES M.D.

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	174400000X	Specialist	ME123956	FL
2	174400000X	Specialist	167466	NY

General Provider Information

NPI Number	:	1790726875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOAN JONES M.D.

Provider Business Mailing Address
First Line	:	122 HORTON ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10464-1651
Country	:	US
Telephone Number	:	917-854-8512
Fax Number	:	212-746-3856

Provider Business Practice Location Address
First Line	:	122 HORTON ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10464
Country	:	US
Telephone Number	:	917-854-8512
Fax Number	:

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	03/05/2019

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Directions to “ DR. JOAN JONES M.D.” Practice Location

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