Provider Demographics
NPI:1407857204
Name:JONES, BERESFORD ANDREW (DO)
Entity Type:Individual
Prefix:MR
First Name:BERESFORD
Middle Name:ANDREW
Last Name:JONES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 HEMPSTEAD TPKE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-5700
Mailing Address - Country:US
Mailing Address - Phone:516-735-3030
Mailing Address - Fax:516-735-3285
Practice Address - Street 1:4230 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 205
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-5700
Practice Address - Country:US
Practice Address - Phone:516-735-3030
Practice Address - Fax:516-735-3285
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166601207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01458915Medicaid
NY12F091Medicare ID - Type Unspecified
NY01458915Medicaid