Pandolfi, Jacqueline

Pandolfi, Jacqueline is an individual health care provider with primary practice located at 12 Medical Dr , Port Jefferson Station NY 11776-1588. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Women's Health, which is considered as her primary health care specialty. Pandolfi, Jacqueline can be contacted via phone (631) 331-4400.

Contact Information

Primary practice address
12 Medical Dr Port Jefferson Station NY 11776-1588
Phone: (631) 331-4400
Fax: (631) 331-3190
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Women's Health 363LW0102X 388956-1 New York

Profile Details

NPI number 1225197866
LBN Legal business name Pandolfi, Jacqueline
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 8th, 2006
Last updated Jan 14th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1225197866 NPPES
New York MEDICAID 388956

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