MEDICARE: JANA GALE VENGRIN NP

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	363L00000X	Nurse Practitioner	F400818-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F400818-1	OTHER	NY	NYS NP LICENSE

General Provider Information

NPI Number	:	1588656441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANA GALE VENGRIN NP

Provider Business Mailing Address
First Line	:	7875 ALBANY POST ROAD
Second Line	:
City	:	RED HOOK
State	:	NY
Zip	:	12571
Country	:	US
Telephone Number	:	845-594-5229
Fax Number	:

Provider Business Practice Location Address
First Line	:	7875 ALBANY POST RD
Second Line	:
City	:	RED HOOK
State	:	NY
Zip	:	12571-2147
Country	:	US
Telephone Number	:	845-758-8101
Fax Number	:	845-758-8102

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	03/07/2023

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