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General NPI Number Information
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NPI Number | 1497385702
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Entity Type | Individual
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Provider Name | PETER EDWARD JAKUBOWSKI LPN
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Gender | Male
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Dates
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Enumeration Date | 01/26/2020
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Last Update Date | 01/26/2020
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Provider Practice Location Address
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Address Line | 6054 CAVANAUGH RD
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City | MARCY
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State | NY
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Zip | 13403-2411
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Country | US
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Telephone | 315-534-0730
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Fax |
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Provider Business Mailing Address
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Address Line | 443 STONE ST
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City | ONEIDA
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State | NY
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Zip | 13421-1933
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Country | US
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Telephone | 315-813-2760
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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 | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 29554301
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License Number State | NY
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