Healthcare Provider Details

I. General information

NPI: 1124771084
Provider Name (Legal Business Name): TROY JONES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PROSPECT ST
EAST STROUDSBURG PA
18301-2956
US

IV. Provider business mailing address

1132 DORSET DR
BUSHKILL PA
18324-6865
US

V. Phone/Fax

Practice location:
  • Phone: 609-414-8302
  • Fax:
Mailing address:
  • Phone: 609-414-8302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: