Provider Demographics
NPI:1831490069
Name:PEDRO, JUBRIL TOLANI JR (LPN/LMT)
Entity Type:Individual
Prefix:
First Name:JUBRIL
Middle Name:TOLANI
Last Name:PEDRO
Suffix:JR
Gender:M
Credentials:LPN/LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3102 ELMWOOD AVE
Mailing Address - Street 2:APT.11
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2018
Mailing Address - Country:US
Mailing Address - Phone:585-957-5839
Mailing Address - Fax:
Practice Address - Street 1:3102 ELMWOOD AVE
Practice Address - Street 2:APT.11
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2018
Practice Address - Country:US
Practice Address - Phone:585-957-5839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295254164W00000X
NY021140225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist