Provider Demographics
NPI:1922136712
Name:POGGIOLI, JESSICA R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:R
Last Name:POGGIOLI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:R
Other - Last Name:PAGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:7 W 36TH ST
Mailing Address - Street 2:FLOOR 15
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-7911
Mailing Address - Country:US
Mailing Address - Phone:212-874-8180
Mailing Address - Fax:
Practice Address - Street 1:7 W 36TH ST
Practice Address - Street 2:FLOOR 15
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-7911
Practice Address - Country:US
Practice Address - Phone:212-874-8180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015601103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVM3131Medicare ID - Type Unspecified