Healthcare Provider Details

I. General information

NPI: 1649941956
Provider Name (Legal Business Name): JODECY COLON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2021
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8910 JAMAICA AVE
JAMAICA NY
11421-2040
US

IV. Provider business mailing address

30 HUNTER LN
CAMP HILL PA
17011-2400
US

V. Phone/Fax

Practice location:
  • Phone: 718-849-7777
  • Fax:
Mailing address:
  • Phone: 800-748-3243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number824689
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: