Jubril Tolani Pedro Jr., L.P.N/L.M.T

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

295254 Issued in NY

Practice address

3102 Elmwood Ave
Apt.11
Rochester, NY 14618-2018

Phone

(585) 957-5839

NPI assigned

Nov 4, 2010

Last updated

Nov 4, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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": "1288828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288828800000",
    "number": "1831490069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3102 ELMWOOD AVE",
            "address_2": "APT.11",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146182018",
            "telephone_number": "585-957-5839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3102 ELMWOOD AVE",
            "address_2": "APT.11",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146182018",
            "telephone_number": "585-957-5839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDRO",
        "first_name": "JUBRIL",
        "middle_name": "TOLANI",
        "name_suffix": "Jr.",
        "credential": "L.P.N/L.M.T",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-11-04",
        "last_updated": "2010-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "295254",
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "NY",
            "license": "021140",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pediatric Pulmonology
• Pediatric Radiology of the University of Rochester
• Pediatrics & Adolescent Medicine Group
• Pediatrics Hematolgy Onocology
• Joanne L Pedro Carroll, PHD
• Kimberly Pedrotti
• Angelo J Pedulla, MD
• Sara Marie Pedulla, NP
• Clara Peechatt, LMSW
• Thomas Peechatt, MHC

• Licensed Practical Nurse in Rochester, NY
• Providers in Rochester, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 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.