Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | N004241-1 | NY |
Y | 213ES0000X | Sports Medicine | N004241-1 | NY |
NPI | 1043238181 |
---|---|
Provider Name | Richard E Jones |
First Address | Saratoga Springs, NY 12866 |
Second Address | Saratoga Springs, NY 12866-1346 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 25/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03189519 | (05) | NY |
141824381 | TAX ID# (01) | NY |
T11615 | (02) | NY |