Provider Demographics
NPI:1396035309
Name:MASLOSKY, JADE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:JADE
Middle Name:
Last Name:MASLOSKY
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SCHOOL DR
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-2920
Mailing Address - Country:US
Mailing Address - Phone:631-921-0366
Mailing Address - Fax:
Practice Address - Street 1:19 SCHOOL DR
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2920
Practice Address - Country:US
Practice Address - Phone:631-921-0366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY812011163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY16400000XMedicare UPIN