Van Der Jagt, Elise W
Van Der Jagt, Elise W is an individual health care provider with primary practice located at 601 Elmwood Ave Box 635, Rochester NY 14642-0001. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine. Allopathic & Osteopathic Physicians / Pediatrics is his primary health care specialty. Van Der Jagt, Elise W can be contacted via phone (585) 275-8138.Contact Information
Primary practice address
601 Elmwood Ave Box 635
Rochester NY 14642-0001
Phone: (585) 275-8138
Fax: (585) 275-2352
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 124938 | New York |
Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine | 2080P0203X | 124938 | New York |
Profile Details
NPI number | 1083650949 |
---|---|
LBN Legal business name | Van Der Jagt, Elise W |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Jun 21st, 2006 |
Last updated | Jul 8th, 2007 - about 17 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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1083650949 | NPPES |
New York | MEDICAID | 00512863 |
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