Healthcare Provider Details

I. General information

NPI: 1134350291
Provider Name (Legal Business Name): JAIME ANTONIO RODRIGUEZ LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 OLD FARM ROAD
NAPANOCH NY
12458
US

IV. Provider business mailing address

11 OLD FARM RD
NAPANOCH NY
12458-2618
US

V. Phone/Fax

Practice location:
  • Phone: 845-594-7756
  • Fax: 845-210-4716
Mailing address:
  • Phone: 845-594-7756
  • Fax: 845-210-4716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number288387
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: