Provider Demographics
NPI:1255692117
Name:TECKERT, JACQUELIN (MS)
Entity Type:Individual
Prefix:
First Name:JACQUELIN
Middle Name:
Last Name:TECKERT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 GREENHILLS RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3905
Mailing Address - Country:US
Mailing Address - Phone:631-351-1111
Mailing Address - Fax:
Practice Address - Street 1:3 GREENHILLS RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-3905
Practice Address - Country:US
Practice Address - Phone:631-351-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist