Provider Demographics
NPI:1508260571
Name:ENGLISH, JACQUELYN E (DO)
Entity Type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:E
Last Name:ENGLISH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 NEW HAMPSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-1317
Mailing Address - Country:US
Mailing Address - Phone:407-234-4047
Mailing Address - Fax:
Practice Address - Street 1:151 HERRICKS RD STE 102
Practice Address - Street 2:
Practice Address - City:GARDEN CITY PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-5200
Practice Address - Country:US
Practice Address - Phone:516-741-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY286626207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program