Provider Demographics
NPI:1548678378
Name:WELCH, JEFFREY BRIAN (RN)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:BRIAN
Last Name:WELCH
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 1:912 AMSTERDAM AVENUE
Mailing Address - Street 2:THE BRIDGE RESIDENTIAL ADMINISTRATIVE OFFICE
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10025
Mailing Address - Country:US
Mailing Address - Phone:212-665-2531
Mailing Address - Fax:212-665-2536
Practice Address - Street 1:912 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3925
Practice Address - Country:US
Practice Address - Phone:212-665-2531
Practice Address - Fax:212-665-2536
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY682379163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse