Provider Demographics
NPI:1790726875
Name:JONES, JOAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 HORTON ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10464-1651
Mailing Address - Country:US
Mailing Address - Phone:917-854-8512
Mailing Address - Fax:212-746-3856
Practice Address - Street 1:122 HORTON ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10464
Practice Address - Country:US
Practice Address - Phone:917-854-8512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME123956174400000X
NY167466174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10G531Medicare ID - Type Unspecified