Provider Demographics
NPI:1588674329
Name:JAEGER, MICHAEL G (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:JAEGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 LEGRAND AVE
Mailing Address - Street 2:
Mailing Address - City:TIVOLI
Mailing Address - State:NY
Mailing Address - Zip Code:12583-5023
Mailing Address - Country:US
Mailing Address - Phone:518-537-5873
Mailing Address - Fax:518-537-5873
Practice Address - Street 1:125 HARRY HOWARD AVE
Practice Address - Street 2:FIREMENS NURSING HOME
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-1601
Practice Address - Country:US
Practice Address - Phone:518-828-7695
Practice Address - Fax:518-828-0561
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188311207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01833412Medicaid
G12074Medicare UPIN
280221Medicare ID - Type Unspecified