=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215207683
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JACQUELINE DAUHAJRE, M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2012
-----------------------------------------------------
Last Update Date | 01/03/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 140 E 80TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10075-0306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-553-5220
-----------------------------------------------------
Fax | 917-338-2607
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 75 E END AVE #2C
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10028-7909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-519-1171
-----------------------------------------------------
Fax | 917-338-2607
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JACQUELINE DAUHAJRE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 917-519-1171
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 176455
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------