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General NPI Number Information
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NPI Number | 1629202783
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Entity Type | Individual
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Provider Name | JACLYN SISSKIND MD
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Gender | Female
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Dates
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Enumeration Date | 05/05/2009
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Last Update Date | 09/27/2024
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Provider Practice Location Address
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Address Line | 3448 ROUTE 31
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City | BALDWINSVILLE
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State | NY
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Zip | 13027
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Country | US
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Telephone | 315-622-6395
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Fax | 315-622-3298
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Provider Business Mailing Address
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Address Line | 3448 ROUTE 31
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City | BALDWINSVILLE
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State | NY
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Zip | 13027
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Country | US
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Telephone | 315-622-6395
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Fax | 315-622-3298
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 264529
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License Number State | NY
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