Healthcare Provider Details

I. General information

NPI: 1588656441
Provider Name (Legal Business Name): JANA GALE VENGRIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 03/07/2023
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7875 ALBANY POST RD
RED HOOK NY
12571-2147
US

IV. Provider business mailing address

7875 ALBANY POST ROAD
RED HOOK NY
12571
US

V. Phone/Fax

Practice location:
  • Phone: 845-758-8101
  • Fax: 845-758-8102
Mailing address:
  • Phone: 845-594-5229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF400818-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: