Healthcare Provider Details

I. General information

NPI: 1598079956
Provider Name (Legal Business Name): TODD M JARRELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N OCEAN AVE
PATCHOGUE NY
11772-1758
US

IV. Provider business mailing address

PO BOX 5036
WHITE PLAINS NY
10602-5036
US

V. Phone/Fax

Practice location:
  • Phone: 631-866-2030
  • Fax: 631-866-2033
Mailing address:
  • Phone: 914-898-9421
  • Fax: 914-734-8786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number308193
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberML60165757
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP3735
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: