Provider Demographics
NPI:1255475133
Name:PARENT, JAIME L (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:L
Last Name:PARENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JAIME
Other - Middle Name:L
Other - Last Name:GRIMLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2270
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12402-2270
Mailing Address - Country:US
Mailing Address - Phone:845-943-5841
Mailing Address - Fax:845-338-5616
Practice Address - Street 1:45 PINE GROVE AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401
Practice Address - Country:US
Practice Address - Phone:845-340-4500
Practice Address - Fax:845-340-4501
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4392362085R0202X
NY2627082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03271950Medicaid
PA102480767Medicaid