Healthcare Provider Details

I. General information

NPI: 1962512178
Provider Name (Legal Business Name): WILLIAM B JONES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 N VILLAGE AVE SUITE # 5
ROCKVILLE CENTRE NY
11570-3761
US

IV. Provider business mailing address

165 N VILLAGE AVE SUITE # 5
ROCKVILLE CENTRE NY
11570-3761
US

V. Phone/Fax

Practice location:
  • Phone: 516-766-0393
  • Fax: 516-766-2405
Mailing address:
  • Phone: 516-766-0393
  • Fax: 516-766-2405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number209039
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: