Bridget Jaylene Rabideau

Primary specialty

OpticianTaxonomy code 156FX1800X

License

009005-1 Issued in NY

Practice address

155 Finny Blvd
Malone, NY 12953

Phone

(518) 483-0109

Fax

(518) 483-0115

NPI assigned

Apr 7, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mrs. Bridget Jaylene Herne Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1270598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1270598400000",
    "number": "1609191261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 FINNY BLVD",
            "city": "MALONE",
            "state": "NY",
            "postal_code": "12953",
            "telephone_number": "518-483-0109",
            "fax_number": "518-483-0115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 FINNY BLVD",
            "city": "MALONE",
            "state": "NY",
            "postal_code": "12953",
            "telephone_number": "518-483-0109",
            "fax_number": "518-483-0115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RABIDEAU",
        "first_name": "BRIDGET",
        "middle_name": "JAYLENE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-07",
        "last_updated": "2010-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "NY",
            "license": "009005-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01995615",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRIDGET",
            "last_name": "HERNE",
            "middle_name": "JAYLENE",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kim M Premo, RN
• Lauren Elizabeth-Anne Premo
• Heather Marie Pryce
• Christine Michelle Quinn, RN
• Ruben Jay Quinones, CASAC
• Kyle Giles Rabideau, PHARMD
• Michelle Marie Rabideau
• Norma Alice Race, R.N.
• Dorene Raimondo
• Rajiv S Shah Physician P C

• Optician in Malone, NY
• Providers in Malone, NY by specialty
• Optician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2010; 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.