Provider Demographics
NPI:1407158470
Name:JLP MEDICINE, PC
Entity Type:Organization
Organization Name:JLP MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:PESKA MOSSERI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-306-4935
Mailing Address - Street 1:10 TIMOTHY LN
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4560
Mailing Address - Country:US
Mailing Address - Phone:732-306-4935
Mailing Address - Fax:732-238-7115
Practice Address - Street 1:2035 RALPH AVE
Practice Address - Street 2:SUITE A-4
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5300
Practice Address - Country:US
Practice Address - Phone:732-306-4935
Practice Address - Fax:732-238-7115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257892261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center