Provider Demographics
NPI:1114151545
Name:COLE, JODIE (LAC)
Entity Type:Individual
Prefix:MS
First Name:JODIE
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MRS
Other - First Name:JODIE
Other - Middle Name:
Other - Last Name:COLE SCHWARTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:23 SHOREHAM DR W
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6580
Mailing Address - Country:US
Mailing Address - Phone:917-868-4735
Mailing Address - Fax:631-667-2791
Practice Address - Street 1:23 SHOREHAM DR W
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-6580
Practice Address - Country:US
Practice Address - Phone:917-868-4735
Practice Address - Fax:631-667-2791
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004075171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist