Provider Demographics
NPI:1154719292
Name:JONES, MARIO
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:JONES
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 1:350 S MANNING BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-1733
Mailing Address - Country:US
Mailing Address - Phone:518-221-6439
Mailing Address - Fax:
Practice Address - Street 1:350 S MANNING BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1733
Practice Address - Country:US
Practice Address - Phone:518-221-6439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-23
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296704251B00000X, 251J00000X, 302R00000X, 332U00000X, 347E00000X
343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No332U00000XSuppliersHome Delivered Meals
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)