Provider Demographics
NPI:1629663018
Name:FLEDERBACHTAGLIENTI, JOMARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:JOMARIE
Middle Name:
Last Name:FLEDERBACHTAGLIENTI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 RADIO CIRCLE DR STE 309
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-2631
Mailing Address - Country:US
Mailing Address - Phone:914-666-0191
Mailing Address - Fax:914-666-9107
Practice Address - Street 1:41 PAGE PARK DR
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-7500
Practice Address - Country:US
Practice Address - Phone:845-486-2850
Practice Address - Fax:845-486-2770
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339140-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse