1790859411 NPI number — MR. NICHOLAS MATTHEW JONES D.O.

Table of content: SONIA DORAME (NPI 1780353078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790859411 NPI number — MR. NICHOLAS MATTHEW JONES D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
NICHOLAS
Provider Middle Name:
MATTHEW
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

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:
1790859411
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35 PINELAWN ROAD
Provider Second Line Business Mailing Address:
SUITE 112
Provider Business Mailing Address City Name:
MELVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-393-6838
Provider Business Mailing Address Fax Number:
631-393-6837

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
285 E MAIN ST
Provider Second Line Business Practice Location Address:
SUITE LL5
Provider Business Practice Location Address City Name:
SMITHTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11787-2978
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-366-4350
Provider Business Practice Location Address Fax Number:
631-366-4354
Provider Enumeration Date:
11/17/2006

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: 204D00000X , with the licence number:  213199 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081S0010X , with the licence number: 213199 , 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: 213199-3B . This is a "WORKERS' COMPENSATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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