Provider Demographics
NPI:1336253285
Name:EASTMAN, JILLIAN L (NPC)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:L
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:L
Other - Last Name:RUMENAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NPC
Mailing Address - Street 1:945 E. GENESEE STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210
Mailing Address - Country:US
Mailing Address - Phone:315-475-0689
Mailing Address - Fax:315-234-3276
Practice Address - Street 1:945 E. GENESEE STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-475-0689
Practice Address - Fax:315-234-3276
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334811363LF0000X
NY7334811-1207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00334811Medicaid
NYRB5823OtherMEDICARE PTAN
RB5823Medicare PIN