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General NPI Number Information
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NPI Number | 1447747100
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Entity Type | Individual
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Provider Name | JON AGRICOLA
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Gender | Male
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Dates
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Enumeration Date | 04/18/2018
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Last Update Date | 10/15/2018
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Provider Practice Location Address
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Address Line | 2202 GENESEE ST
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City | UTICA
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State | NY
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Zip | 13502-5809
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Country | US
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Telephone | 315-374-1338
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Fax |
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Provider Business Mailing Address
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Address Line | 2202 GENESEE ST
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City | UTICA
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State | NY
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Zip | 13502-5809
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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