Provider Demographics
NPI:1457485740
Name:JAEGER, JUDITH (PHD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:JAEGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75-59 263RD STREET
Mailing Address - Street 2:THE ZUCKER HILLSIDE HOSPITAL-PSYCH REHAB
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004
Mailing Address - Country:US
Mailing Address - Phone:718-470-8342
Mailing Address - Fax:
Practice Address - Street 1:75-59 263RD STREET
Practice Address - Street 2:THE ZUCKER HILLSIDE HOSPITAL-PSYCH REHAB
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004
Practice Address - Country:US
Practice Address - Phone:718-470-8342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8207103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist