Provider Demographics
NPI:1518026707
Name:TRIEGEL, JOHANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:
Last Name:TRIEGEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 OLD BULLS HEAD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON CORNERS
Mailing Address - State:NY
Mailing Address - Zip Code:12514-2856
Mailing Address - Country:US
Mailing Address - Phone:845-266-3595
Mailing Address - Fax:845-677-2101
Practice Address - Street 1:194 OLD BULLS HEAD RD
Practice Address - Street 2:
Practice Address - City:CLINTON CORNERS
Practice Address - State:NY
Practice Address - Zip Code:12514-2856
Practice Address - Country:US
Practice Address - Phone:845-266-3595
Practice Address - Fax:845-677-2101
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1404162080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00807070Medicaid