Jack E. Redding II, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9100926 Issued in FL

Practice address

11835 RT 9W
West Coxsackie, NY 12192-3605

Phone

(518) 731-9000

Fax

(518) 731-9119

NPI assigned

Aug 25, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427414400000",
    "number": "1295843852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 MARTINS HILL RD",
            "city": "RAVENA",
            "state": "NY",
            "postal_code": "121432809",
            "telephone_number": "518-694-2965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11835 RT 9W",
            "city": "WEST COXSACKIE",
            "state": "NY",
            "postal_code": "121923605",
            "telephone_number": "518-731-9000",
            "fax_number": "518-731-9119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDDING",
        "first_name": "JACK",
        "middle_name": "E.",
        "name_suffix": "II",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2015-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9100926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marvin a. Gertzberg, D.D.S.
• Colleen McNally, PT
• Nicole Elizabeth Mokszycki, PA-C
• New Baltimore Family Dentistry, LLP
• Robert Ordish, PA-C
• Ethel Cabanas Rodgers, LMHC
• Brandon Smith, PA
• Erin Kimberly Smith I, DPT
• Alison H Spear, MD
• Jennifer Michele Stall, PA-C

• Medical Physician Assistant in West Coxsackie, NY
• Providers in West Coxsackie, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.