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General NPI Number Information
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NPI Number | 1508112442
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Entity Type | Individual
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Provider Name | JACLYN M VIRGIL MS
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Gender | Female
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Dates
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Enumeration Date | 07/30/2012
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Last Update Date | 07/30/2012
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Provider Practice Location Address
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Address Line | 145 WILLIAM FLOYD PKWY
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City | SHIRLEY
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State | NY
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Zip | 11967-3441
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Country | US
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Telephone | 631-327-1850
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 428
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City | SHIRLEY
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State | NY
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Zip | 11967-0428
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Country | US
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Telephone | 631-327-1850
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 305369
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License Number State | NY
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