MEDICARE: MR. JEFFERY JASON VIRGO OTC, OPA-C, LSA

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	246ZS0410X	Surgical Technologist
2	246ZX2200X	Orthopedic Assistant	O000066-	NY

General Provider Information

NPI Number	:	1073589602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFERY JASON VIRGO OTC, OPA-C, LSA

Provider Business Mailing Address
First Line	:	703 MALLARD WAY
Second Line	:
City	:	PEEKSKILL
State	:	NY
Zip	:	10566-4178
Country	:	US
Telephone Number	:	914-737-5608
Fax Number	:

Provider Business Practice Location Address
First Line	:	234 E 149TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-5504
Country	:	US
Telephone Number	:	718-579-5919
Fax Number	:	718-579-4620

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

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	02/02/2023

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Directions to “ MR. JEFFERY JASON VIRGO OTC, OPA-C, LSA” Practice Location

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