Basic Information
| Provider Information | |||||||||
| NPI: | 1124109616 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | AIMEE | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PHYSICIAN ASSISTANT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26666 | ||||||||
| Address2: | PROVIDER ENROLLMENT | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871256666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059236770 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2 NEW HAMPSHIRE AVE STE 100 | ||||||||
| Address2: | PULMONARY & CRITICAL CARE SERVICES | ||||||||
| City: | TROY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121801762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182720331 | ||||||||
| FaxNumber: | 5182719007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 02/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA2018-0071 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 017793 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 03534576 | 05 | NY | MEDICAID |