Healthcare Provider Details

I. General information

NPI: 1609784750
Provider Name (Legal Business Name): JAIMIE KRUEGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HUTCHINSON RIVER PKWY
BRONX NY
10465-1899
US

IV. Provider business mailing address

1303 AUERBACH AVE
HEWLETT NY
11557-2744
US

V. Phone/Fax

Practice location:
  • Phone: 718-828-9000
  • Fax:
Mailing address:
  • Phone: 516-721-7548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number036999
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: