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NPI Code Detail

MEDICARE: JACK E. REDDING II PA-C

MEDICARE: JACK E. REDDING II PA-C
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
1363AM0700XMedical Physician AssistantPA9100926FL

General Provider Information

NPI Number : 1295843852
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACK E. REDDING II PA-C
Provider Business Mailing Address
First Line : 60 MARTINS HILL RD
Second Line :
City : RAVENA
State : NY
Zip : 12143-2809
Country : US
Telephone Number : 518-694-2965
Fax Number :
Provider Business Practice Location Address
First Line : 11835 RT 9W
Second Line :
City : WEST COXSACKIE
State : NY
Zip : 12192-3605
Country : US
Telephone Number : 518-731-9000
Fax Number : 518-731-9119
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2006
Last Update Date : 03/27/2015

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Directions to “ JACK E. REDDING II PA-C” Practice Location

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