Basic Information
| Provider Information | |||||||||
| NPI: | 1902042286 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JEFFERSON | ||||||||
| FirstName: | JONI | ||||||||
| MiddleName: | FELICIA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1345 RXR PLZ FL 13 | ||||||||
| Address2: | |||||||||
| City: | UNIONDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115561301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164530435 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 852 ROUTE 3 STE 200 | ||||||||
| Address2: | |||||||||
| City: | CLIFTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070122344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734501991 | ||||||||
| FaxNumber: | 9735288009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2008 | ||||||||
| LastUpdateDate: | 07/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 0T012760 | PA | N | Other Service Providers | Specialist | 207Q00000X | 282442 | NY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 25MB09143600 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.