MEDICARE: JAQUELINE M WORTH MD

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
1	207VX0000X	Obstetrics Physician	211448	NY
2	207V00000X	Obstetrics & Gynecology Physician	211448	NY

General Provider Information

NPI Number	:	1619971975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAQUELINE M WORTH MD

Provider Business Mailing Address
First Line	:	1225 PARK AVE
Second Line	:	SUITE 1D
City	:	NEW YORK
State	:	NY
Zip	:	10128-1758
Country	:	US
Telephone Number	:	212-741-2229
Fax Number	:	212-741-2228

Provider Business Practice Location Address
First Line	:	1225 PARK AVE STE 1D
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-1758
Country	:	US
Telephone Number	:	212-741-2229
Fax Number	:	212-741-2228

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	02/01/2023

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Directions to “ JAQUELINE M WORTH MD” Practice Location

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