Provider Demographics
NPI:1215567482
Name:DEBENEDICTIS, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:DEBENEDICTIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 SINGINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-2818
Mailing Address - Country:US
Mailing Address - Phone:631-707-0952
Mailing Address - Fax:
Practice Address - Street 1:23 SINGINGWOOD DR
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-2818
Practice Address - Country:US
Practice Address - Phone:631-707-0952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide