Healthcare Provider Details

I. General information

NPI: 1184534794
Provider Name (Legal Business Name): MR. FREDERICK LEE JONES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 WALDRON AVE
NYACK NY
10960-2935
US

IV. Provider business mailing address

25 WALDRON AVE
NYACK NY
10960-2935
US

V. Phone/Fax

Practice location:
  • Phone: 877-468-3690
  • Fax: 919-296-1331
Mailing address:
  • Phone: 877-468-3690
  • Fax: 919-296-1331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: