Provider Demographics
NPI:1750341087
Name:ARLISS, JEFFREY JAMES (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:JAMES
Last Name:ARLISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 HURLEY AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3738
Mailing Address - Country:US
Mailing Address - Phone:845-334-8494
Mailing Address - Fax:845-334-8497
Practice Address - Street 1:40 HURLEY AVE STE 2
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3738
Practice Address - Country:US
Practice Address - Phone:845-334-8494
Practice Address - Fax:845-334-8497
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160958207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01125644Medicaid
NY01125644Medicaid
E17198Medicare UPIN