Mack-Fogg, Jean Elizabeth

Mack-Fogg, Jean Elizabeth is an individual health care provider with primary practice located at 601 Elmwood Ave , Rochester NY 14642. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Mack-Fogg, Jean Elizabeth can be contacted via phone (585) 275-7787.

Contact Information

Primary practice address
601 Elmwood Ave Rochester NY 14642
Phone: (585) 275-7787
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X F380190 New York
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 7475 Connecticut

Profile Details

NPI number 1023048600
LBN Legal business name Mack-Fogg, Jean Elizabeth
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 3rd, 2006
Last updated Jul 24th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1023048600 NPPES
New York MEDICAID 02299521

Popular Providers