Healthcare Provider Details

I. General information

NPI: 1255991014
Provider Name (Legal Business Name): HAILEY MARIE HAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 VARET ST
BROOKLYN NY
11206-4014
US

IV. Provider business mailing address

95 W 6TH ST
CORNING NY
14830-3039
US

V. Phone/Fax

Practice location:
  • Phone: 718-925-2397
  • Fax:
Mailing address:
  • Phone: 607-329-7922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-40309
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: