MEDICARE: MR. ROBERT JOHN JONES M.ED. , ATC

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	2255A2300X	Athletic Trainer	1112696	NY

General Provider Information

NPI Number	:	1235895400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT JOHN JONES M.ED. , ATC

Provider Business Mailing Address
First Line	:	409 AVIATION RD
Second Line	:
City	:	QUEENSBURY
State	:	NY
Zip	:	12804-2913
Country	:	US
Telephone Number	:	518-824-4600
Fax Number	:	518-824-4682

Provider Business Practice Location Address
First Line	:	409 AVIATION RD
Second Line	:
City	:	QUEENSBURY
State	:	NY
Zip	:	12804-2913
Country	:	US
Telephone Number	:	518-824-4600
Fax Number	:	518-824-4682

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

Provider Enumeration Date	:	11/12/2021
Last Update Date	:	11/12/2021

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