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NPI Code Detail

MEDICARE: MS. JACQUELINE PANDOLFI N.P.

MEDICARE: MS. JACQUELINE PANDOLFI N.P.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LW0102XWomen's Health Nurse Practitioner388956-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225197866
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JACQUELINE PANDOLFI N.P.
Provider Business Mailing Address
First Line : 900 MERCHANTS CONCOURSE STE 216
Second Line :
City : WESTBURY
State : NY
Zip : 11590-5114
Country : US
Telephone Number : 516-226-8373
Fax Number : 844-632-8265
Provider Business Practice Location Address
First Line : 12 MEDICAL DR
Second Line :
City : PORT JEFFERSON STATION
State : NY
Zip : 11776-1588
Country : US
Telephone Number : 631-331-4400
Fax Number : 631-331-3190
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2006
Last Update Date : 01/14/2021

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