Provider Demographics
NPI:1669463006
Name:VAN AUKEN, JEAN ELIZABETH (PA)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:ELIZABETH
Last Name:VAN AUKEN
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 ROUTE 50 STE 1
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-3073
Mailing Address - Country:US
Mailing Address - Phone:518-580-2170
Mailing Address - Fax:518-926-6983
Practice Address - Street 1:3040 ROUTE 50 STE 1
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-3073
Practice Address - Country:US
Practice Address - Phone:518-580-2170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005471363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00009681OtherRR MEDICARE
NY02347831Medicaid
NYP00009681OtherRR MEDICARE
NY02347831Medicaid