Provider Demographics
NPI:1144837642
Name:ARREDONDO, JASSON S (RN)
Entity type:Individual
Prefix:
First Name:JASSON
Middle Name:S
Last Name:ARREDONDO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 KELLY ST
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-3800
Mailing Address - Country:US
Mailing Address - Phone:516-303-2383
Mailing Address - Fax:
Practice Address - Street 1:2 KELLY ST
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-3800
Practice Address - Country:US
Practice Address - Phone:516-303-2383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY800881163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse