1770868630 NPI number — JILLIAN LINDSEY JONES CPNP-BC, RN

Table of content: JILLIAN LINDSEY JONES CPNP-BC, RN (NPI 1770868630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770868630 NPI number — JILLIAN LINDSEY JONES CPNP-BC, RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
JILLIAN
Provider Middle Name:
LINDSEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPNP-BC, RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770868630
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ERIVER NEUROLOGY OF NEW YORK LLC
Provider Second Line Business Mailing Address:
21 FOX STREET, SUITE 102
Provider Business Mailing Address City Name:
POUGHKEEPSIE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12601-4723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-452-9750
Provider Business Mailing Address Fax Number:
845-452-9751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ERIVER NEUROLOGY OF NEW YORK LLC
Provider Second Line Business Practice Location Address:
200 WESTAGE BUS CTR DR., SUTIE 324
Provider Business Practice Location Address City Name:
FISHKILL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12524-2265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-452-9750
Provider Business Practice Location Address Fax Number:
845-452-9751
Provider Enumeration Date:
10/11/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  F382081 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: F382081 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03427254 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".