Provider Demographics
NPI:1295997732
Name:MEANEY, JEFFFERY PATRICK (LPN)
Entity type:Individual
Prefix:MR
First Name:JEFFFERY
Middle Name:PATRICK
Last Name:MEANEY
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 GORDON PKWY
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-1064
Mailing Address - Country:US
Mailing Address - Phone:315-214-5028
Mailing Address - Fax:
Practice Address - Street 1:40 GORDON PKWY
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-1064
Practice Address - Country:US
Practice Address - Phone:315-214-5028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291718164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse