Healthcare Provider Details

I. General information

NPI: 1205169372
Provider Name (Legal Business Name): JILLIAN M IVES PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GENESEE ST STE A
ONEIDA NY
13421-2644
US

IV. Provider business mailing address

301 GENESEE ST STE A
ONEIDA NY
13421-2644
US

V. Phone/Fax

Practice location:
  • Phone: 315-606-2601
  • Fax: 315-361-2972
Mailing address:
  • Phone: 315-606-2601
  • Fax: 315-361-2972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: