Healthcare Provider Details

I. General information

NPI: 1326524331
Provider Name (Legal Business Name): ANTHONY JONES MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 ALBANY SHAKER RD
ALBANY NY
12211
US

IV. Provider business mailing address

18 KNAUF LN
LOUDONVILLE NY
12211-2102
US

V. Phone/Fax

Practice location:
  • Phone: 518-869-2231
  • Fax:
Mailing address:
  • Phone: 402-730-2268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number276596
License Number StateNY

VIII. Authorized Official

Name: ANTHONY JONES
Title or Position: CEO
Credential: MD
Phone: 402-730-2268