Provider Demographics
NPI:1619319357
Name:HAGEMANN, JEANNINE L (MSPECIAL EDUCATION)
Entity Type:Individual
Prefix:MS
First Name:JEANNINE
Middle Name:L
Last Name:HAGEMANN
Suffix:
Gender:F
Credentials:MSPECIAL EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 JEWETT AVE
Mailing Address - Street 2:@ND FLOOR
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-2615
Mailing Address - Country:US
Mailing Address - Phone:718-490-7108
Mailing Address - Fax:
Practice Address - Street 1:521 JEWETT AVE
Practice Address - Street 2:@ND FLOOR
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-2615
Practice Address - Country:US
Practice Address - Phone:718-490-7108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161-931-9357174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist