Healthcare Provider Details

I. General information

NPI: 1508831512
Provider Name (Legal Business Name): JAY HERMAN JOERGER EDD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 02/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 DOLSON AVE STE 3
MIDDLETOWN NY
10940-6462
US

IV. Provider business mailing address

102 JOERGERS LANE
DINGMANS FERRY PA
18328
US

V. Phone/Fax

Practice location:
  • Phone: 570-828-6444
  • Fax: 845-344-0392
Mailing address:
  • Phone: 570-828-6444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number9531NY
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number9154PA
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: