Provider Demographics
NPI:1902042286
Name:JEFFERSON, JONI FELICIA (DO)
Entity Type:Individual
Prefix:MRS
First Name:JONI
Middle Name:FELICIA
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 RXR PLZ FL 13
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11556-1301
Mailing Address - Country:US
Mailing Address - Phone:516-453-0435
Mailing Address - Fax:
Practice Address - Street 1:852 ROUTE 3 STE 200
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-2344
Practice Address - Country:US
Practice Address - Phone:973-450-1991
Practice Address - Fax:973-528-8009
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0T012760174400000X
NY282442207Q00000X
NJ25MB09143600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist