Healthcare Provider Details

I. General information

NPI: 1497083158
Provider Name (Legal Business Name): JANICE ANN KUPIDLOWSKI-ROGERS RRT,CPFT,AE-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2009
Last Update Date: 11/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 E ALBANY ST
HERKIMER NY
13350-2016
US

IV. Provider business mailing address

321 E ALBANY ST
HERKIMER NY
13350-2016
US

V. Phone/Fax

Practice location:
  • Phone: 315-867-2885
  • Fax: 315-867-2756
Mailing address:
  • Phone: 315-867-2885
  • Fax: 315-867-2756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number004671
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2279P1006X
TaxonomyPulmonary Function Technologist Registered Respiratory Therapist
License Number004671
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: