Provider Demographics
NPI:1881033157
Name:BAIR, JACQUELINE
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:BAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:TILLSON
Mailing Address - State:NY
Mailing Address - Zip Code:12486-1214
Mailing Address - Country:US
Mailing Address - Phone:845-901-1590
Mailing Address - Fax:
Practice Address - Street 1:4184 ROUTE 9W
Practice Address - Street 2:
Practice Address - City:WEST CAMP
Practice Address - State:NY
Practice Address - Zip Code:12490
Practice Address - Country:US
Practice Address - Phone:845-247-0941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator