Provider Demographics
NPI:1770658924
Name:RICHARD E. JONES,DPM.,LLC
Entity Type:Organization
Organization Name:RICHARD E. JONES,DPM.,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRESEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-583-3338
Mailing Address - Street 1:414 MAPLE AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-5550
Mailing Address - Country:US
Mailing Address - Phone:518-583-3338
Mailing Address - Fax:518-583-2970
Practice Address - Street 1:414 MAPLE AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-5550
Practice Address - Country:US
Practice Address - Phone:518-583-3338
Practice Address - Fax:518-583-2970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004241-1213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03189519Medicaid
NY=========OtherTAX ID
NY50890BMedicare PIN
NYT11615Medicare UPIN