Provider Demographics
NPI:1750404307
Name:AURIGEMA, JACQUELINE A (RPAC)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:A
Last Name:AURIGEMA
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 ROUTE 347 STE 15
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-2054
Mailing Address - Country:US
Mailing Address - Phone:631-331-1000
Mailing Address - Fax:631-928-7436
Practice Address - Street 1:5225 ROUTE 347 STE 15
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2054
Practice Address - Country:US
Practice Address - Phone:631-331-1000
Practice Address - Fax:631-928-7436
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004308363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS53644Medicare UPIN
NYJA0Z881510Medicare ID - Type Unspecified