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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 18 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 1083650949 NPPES
New York MEDICAID 00512863

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