Provider Demographics
NPI:1760073811
Name:MARGARETEN, JACQUELINE MIRIAM (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:MIRIAM
Last Name:MARGARETEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:JACQUELINE
Other - Middle Name:MIRIAM
Other - Last Name:KORFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 MERRICK RD #128
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570
Mailing Address - Country:US
Mailing Address - Phone:516-255-9031
Mailing Address - Fax:
Practice Address - Street 1:100 MERRICK RD STE 128
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4821
Practice Address - Country:US
Practice Address - Phone:516-255-9031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025966207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty