Healthcare Provider Details

I. General information

NPI: 1013953140
Provider Name (Legal Business Name): JANE V. EASON, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ORANGE REGIONAL MEDICAL CENTER 60 PROSPECT AVE
MIDDLETOWN NY
10940
US

IV. Provider business mailing address

PO BOX 468
GOSHEN NY
10924-0468
US

V. Phone/Fax

Practice location:
  • Phone: 845-343-2424
  • Fax:
Mailing address:
  • Phone: 845-615-1141
  • Fax: 845-294-4366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number178623
License Number StateNY

VIII. Authorized Official

Name: JANE VALERIE EASON
Title or Position: OWNER
Credential: MD
Phone: 845-615-1141