Provider Demographics
NPI:1710478029
Name:SISON, JOSE III (LPN)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:SISON
Suffix:III
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LEXINGTON HILLS UNIT 2
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:NY
Mailing Address - Zip Code:10926-3455
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 LEXINGTON HILLS UNIT 2
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:NY
Practice Address - Zip Code:10926-3455
Practice Address - Country:US
Practice Address - Phone:845-642-2337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302975164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY45-2465167OtherHOMECARE