Jacqlene Jacob Johnson

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

046821 Issued in NY

Practice address

224 Beach 20TH St
Far Rockaway, NY 11691-3618

Phone

(347) 926-4037

NPI assigned

Apr 10, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1618012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618012800000",
    "number": "1801476296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "346 SIP AVE",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073066569",
            "telephone_number": "443-447-3230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 BEACH 20TH ST",
            "city": "FAR ROCKAWAY",
            "state": "NY",
            "postal_code": "116913618",
            "telephone_number": "347-926-4037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JACQLENE",
        "middle_name": "JACOB",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-10",
        "last_updated": "2021-04-10",
        "certification_date": "2021-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "046821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Jimenez Chan
• Patricia I Jimoh
• Balinda John, RN
• Elma John, SP. ED. TEACHER
• Caroline Funmilayo Johnson, R.N.
• Letricia E Johnson, LMHC
• Marcel Johnson
• Derek C. Johnston, M.D.
• Jonathan Dembitzer Advanced Physical Therapy
• Jovona Joanne Jones

• Physical Therapist in Far Rockaway, NY
• Providers in Far Rockaway, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.