Healthcare Provider Details

I. General information

NPI: 1245450857
Provider Name (Legal Business Name): PHOENIX MEDICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 01/26/2009
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 Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number209039
License Number StateNY

VIII. Authorized Official

Name: DR. WILLIAM BROWNING JONES JR.
Title or Position: CEO
Credential: MD
Phone: 516-766-0393