Healthcare Provider Details

I. General information

NPI: 1821415704
Provider Name (Legal Business Name): JACQUELINE VAYNKOF M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACQUELINE TROGAN M.D.

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CRAIG RD STE 202
MANALAPAN NJ
07726-8735
US

IV. Provider business mailing address

300 COMMUNITY DR NORTH SHORE-LIJ OFFICE OF GRADUATE MEDICAL EDUCATION
MANHASSET NY
11030-3816
US

V. Phone/Fax

Practice location:
  • Phone: 732-845-2200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number25MA10872100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: