Provider Demographics
NPI:1093711897
Name:JAEGER, LAWRENCE D SR (DO)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:D
Last Name:JAEGER
Suffix:SR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CENTRAL PARK S
Mailing Address - Street 2:STE 107
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:212-262-2500
Mailing Address - Fax:212-246-0890
Practice Address - Street 1:200 CENTRAL PARK S
Practice Address - Street 2:STE 107
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-262-2500
Practice Address - Fax:212-246-0890
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186814207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
32L341Medicare ID - Type Unspecified
F19270Medicare UPIN