Basic Information
| Provider Information | |||||||||
| NPI: | 1326678541 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KACZYNSKI | ||||||||
| FirstName: | JARED | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RN, CNOR, RNFA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 BURGOYNE DR | ||||||||
| Address2: | |||||||||
| City: | HALFMOON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120658104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5189867587 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1367 WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122061069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184892666 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2020 | ||||||||
| LastUpdateDate: | 02/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WR0006X | 702342 | NY | Y | Nursing Service Providers | Registered Nurse | Registered Nurse First Assistant |
No ID Information.