Healthcare Provider Details

I. General information

NPI: 1982604179
Provider Name (Legal Business Name): JANE V EASON M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5138 SEARSVILLE ROAD
PINE BUSH NY
12566
US

IV. Provider business mailing address

5138 SEARSVILLE RD
PINE BUSH NY
12566-6421
US

V. Phone/Fax

Practice location:
  • Phone: 845-342-4774
  • Fax: 845-818-7555
Mailing address:
  • Phone: 845-342-4774
  • Fax: 845-818-7555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number178623
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: