Provider Demographics
NPI:1841706165
Name:ROLO, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:ROLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:L6 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-2822
Mailing Address - Country:US
Mailing Address - Phone:860-485-4898
Mailing Address - Fax:
Practice Address - Street 1:1277 SOUTH ST
Practice Address - Street 2:
Practice Address - City:SUFFIELD
Practice Address - State:CT
Practice Address - Zip Code:06078-2521
Practice Address - Country:US
Practice Address - Phone:860-869-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-22
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1212344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1212OtherPATRIOT TAXI