Healthcare Provider Details

I. General information

NPI: 1689693236
Provider Name (Legal Business Name): JORDAN LAGUIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 BERME ROAD
NAPANOCH NY
12458
US

IV. Provider business mailing address

15 KILE FARM RD
HURLEYVILLE NY
12747-5406
US

V. Phone/Fax

Practice location:
  • Phone: 845-647-1670
  • Fax: 845-647-1685
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number236332
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: