Healthcare Provider Details

I. General information

NPI: 1619846292
Provider Name (Legal Business Name): JESSICA MARIE RONALDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 N KAISERTOWN RD
MONTGOMERY NY
12549-2305
US

IV. Provider business mailing address

283 N KAISERTOWN RD
MONTGOMERY NY
12549-2305
US

V. Phone/Fax

Practice location:
  • Phone: 845-590-1559
  • Fax:
Mailing address:
  • Phone: 845-590-1559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number753535-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: