Provider Demographics
NPI:1285140053
Name:LADOO, JOSE
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:LADOO
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 1:77 GREEN ACRES RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-1008
Mailing Address - Country:US
Mailing Address - Phone:516-612-0528
Mailing Address - Fax:516-887-2565
Practice Address - Street 1:77 GREEN ACRES RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1008
Practice Address - Country:US
Practice Address - Phone:516-612-0528
Practice Address - Fax:516-887-2565
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4556156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician