Provider Demographics
NPI:1912159369
Name:ALSOP, JANE CHAPIN (RN)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:CHAPIN
Last Name:ALSOP
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 DELAFIELD WOODS
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-3900
Mailing Address - Country:US
Mailing Address - Phone:631-686-6294
Mailing Address - Fax:
Practice Address - Street 1:17 DELAFIELD WOODS
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-3900
Practice Address - Country:US
Practice Address - Phone:631-686-6294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY354790-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY354790-1Medicaid