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NPI Code Detail

MEDICARE: JAIME DOLAN

MEDICARE:   JAIME  DOLAN
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
1163W00000XRegistered Nurse677991-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1677991-1OTHERNYLICENSE#

General Provider Information

NPI Number : 1609270677
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAIME DOLAN
Provider Business Mailing Address
First Line : 2228 75TH ST
Second Line :
City : EAST ELMHURST
State : NY
Zip : 11370-1112
Country : US
Telephone Number : 917-617-5109
Fax Number :
Provider Business Practice Location Address
First Line : 2228 75TH ST
Second Line :
City : EAST ELMHURST
State : NY
Zip : 11370-1112
Country : US
Telephone Number : 917-617-5109
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2014
Last Update Date : 10/20/2014

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