MEDICARE: JASON PARRIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	312659-01	NY

General Provider Information

NPI Number	:	1023732658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON PARRIS

Provider Business Mailing Address
First Line	:	4 ELIOT DR
Second Line	:
City	:	LAKE GROVE
State	:	NY
Zip	:	11755-2512
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 ELIOT DR
Second Line	:
City	:	LAKE GROVE
State	:	NY
Zip	:	11755-2512
Country	:	US
Telephone Number	:	631-285-3105
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2022
Last Update Date	:	09/27/2022

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Directions to “ JASON PARRIS ” Practice Location

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