Healthcare Provider Details

I. General information

NPI: 1841478351
Provider Name (Legal Business Name): MR. JASON MICHAEL ROGERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WEST AVE SUITE 230
SARATOGA SPRINGS NY
12866-6045
US

IV. Provider business mailing address

1 WEST AVE SUITE 230
SARATOGA SPRINGS NY
12866-6045
US

V. Phone/Fax

Practice location:
  • Phone: 518-583-5313
  • Fax:
Mailing address:
  • Phone: 518-583-5313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: