1114941846 NPI number — MR. JONATHAN HAGER M.D

Table of content: MR. JONATHAN HAGER M.D (NPI 1114941846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114941846 NPI number — MR. JONATHAN HAGER M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAGER
Provider First Name:
JONATHAN
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114941846
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 505
Provider Second Line Business Mailing Address:
4201 BUFFALO ROAD
Provider Business Mailing Address City Name:
NORTH CHILI
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-594-5995
Provider Business Mailing Address Fax Number:
585-594-5425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4201 BUFFFALO ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH CHILI
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-594-5995
Provider Business Practice Location Address Fax Number:
585-594-5425
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  201397 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5498647 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01789257 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101624BJ . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P010201397 . This is a "BLUE CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P010201397 . This is a "BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com