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General NPI Number Information
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NPI Number | 1548708274
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Entity Type | Individual
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Provider Name | MICHELLE JAEGER N.P.
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Gender | Female
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Dates
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Enumeration Date | 02/01/2017
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Last Update Date | 02/01/2017
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Provider Practice Location Address
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Address Line | 27005 76TH AVE SUITE O-4000
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-1402
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Country | US
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Telephone | 718-470-7305
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Fax |
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Provider Business Mailing Address
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Address Line | 45 STEVENS AVE
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City | MERRICK
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State | NY
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Zip | 11566-2838
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Country | US
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Telephone |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F307919-1
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License Number State | NY
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