Provider Demographics
NPI:1700984143
Name:OWENS, JEFFREY P (RPAC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:P
Last Name:OWENS
Suffix:
Gender:M
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 NELSON ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021
Mailing Address - Country:US
Mailing Address - Phone:315-252-9562
Mailing Address - Fax:315-255-3872
Practice Address - Street 1:77 NELSON ST
Practice Address - Street 2:SUITE 230
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021
Practice Address - Country:US
Practice Address - Phone:315-252-9562
Practice Address - Fax:315-255-3872
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007411363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY369588OtherMVP
NY02315259Medicaid
NYP019007411OtherBLUE CHOICE
NY110609343OtherEXCELLUS BS
NY110609343OtherEXCELLUS BS
NY369588OtherMVP