Provider Demographics
NPI:1306138797
Name:JONES, TODD WILLIAM (PA-C)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:WILLIAM
Last Name:JONES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 942
Mailing Address - Street 2:
Mailing Address - City:FORT DRUM
Mailing Address - State:NY
Mailing Address - Zip Code:13602-0942
Mailing Address - Country:US
Mailing Address - Phone:706-570-2614
Mailing Address - Fax:
Practice Address - Street 1:8881 STATE ROUTE 97
Practice Address - Street 2:
Practice Address - City:CALLICOON
Practice Address - State:NY
Practice Address - Zip Code:12723-5052
Practice Address - Country:US
Practice Address - Phone:845-887-5693
Practice Address - Fax:845-887-5694
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NY014879363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant