MEDICARE: GRACE JEON

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1801432851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE JEON

Provider Business Mailing Address
First Line	:	1029 CARNATION DR
Second Line	:
City	:	NEW MILFORD
State	:	NJ
Zip	:	07646-2507
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1029 CARNATION DR
Second Line	:
City	:	NEW MILFORD
State	:	NJ
Zip	:	07646-2507
Country	:	US
Telephone Number	:	201-914-2232
Fax Number	:

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

Provider Enumeration Date	:	11/25/2019
Last Update Date	:	11/25/2019

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Directions to “ GRACE JEON ” Practice Location

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