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General NPI Number Information
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NPI Number | 1033776877
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Entity Type | Organization
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Legal Business Name | JDE PLATINUM MARKETING LLC
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Dates
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Enumeration Date | 05/28/2019
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Last Update Date | 05/28/2019
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Provider Practice Location Address
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Address Line | 26035 COUNTY ROUTE 3
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City | PLESSIS
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State | NY
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Zip | 13675-2108
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Country | US
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Telephone | 315-771-7731
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Fax |
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Provider Business Mailing Address
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Address Line | 26000 US ROUTE 11 # 283
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City | EVANS MILLS
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State | NY
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Zip | 13637-3320
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Country | US
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Telephone | 315-771-7737
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JUSTIN DAKOTA ERNST
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Credential |
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Telephone | 315-771-7737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 344600000X
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Taxonomy Name | Taxi
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License Number |
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License Number State |
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