Provider Demographics
NPI:1558337485
Name:MULLER, JACQUELINE W (MD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:W
Last Name:MULLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:W
Other - Last Name:MULLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PC
Mailing Address - Street 1:30 DELEVAN LN
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-1302
Mailing Address - Country:US
Mailing Address - Phone:212-585-3161
Mailing Address - Fax:212-585-3162
Practice Address - Street 1:764 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-585-3161
Practice Address - Fax:212-585-3162
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183068207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01522783Medicaid
NY22L201OtherBCBS
NY01522783Medicaid
NY22L201Medicare ID - Type Unspecified