MEDICARE: MR. JONATHAN HAGER M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	201397	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5498647	OTHER	NY	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	101624BJ	OTHER	NY	PREFERRED CARE
4	P010201397	OTHER	NY	BLUE CHOICE
5	P010201397	OTHER	NY	BCBS

General Provider Information

NPI Number	:	1114941846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JONATHAN HAGER M.D

Provider Business Mailing Address
First Line	:	PO BOX 505
Second Line	:	4201 BUFFALO ROAD
City	:	NORTH CHILI
State	:	NY
Zip	:	14514
Country	:	US
Telephone Number	:	585-594-5995
Fax Number	:	585-594-5425

Provider Business Practice Location Address
First Line	:	4201 BUFFFALO ROAD
Second Line	:
City	:	NORTH CHILI
State	:	NY
Zip	:	14514
Country	:	US
Telephone Number	:	585-594-5995
Fax Number	:	585-594-5425

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	10/28/2019

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