Provider Demographics
NPI:1598267429
Name:TEOLI, JONATHAN R (MSPO CPO)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:R
Last Name:TEOLI
Suffix:
Gender:M
Credentials:MSPO CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1559 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-3845
Mailing Address - Country:US
Mailing Address - Phone:401-941-6230
Mailing Address - Fax:401-941-6339
Practice Address - Street 1:1559 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-3845
Practice Address - Country:US
Practice Address - Phone:401-941-6230
Practice Address - Fax:401-941-6339
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier