Provider Demographics
NPI:1235589094
Name:HAGGERTY, JAMES MICHAEL
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:HAGGERTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 JERSEY AVE
Mailing Address - Street 2:APT 2B
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-1313
Mailing Address - Country:US
Mailing Address - Phone:570-510-1144
Mailing Address - Fax:
Practice Address - Street 1:708 JERSEY AVE
Practice Address - Street 2:APT 2B
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-1313
Practice Address - Country:US
Practice Address - Phone:570-510-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program