Provider Demographics
NPI:1104934371
Name:GEORGE M.JAGER, M.D., GIL ROTER, M.D., SCOTT M. ANDES, D.O., LLP
Entity type:Organization
Organization Name:GEORGE M.JAGER, M.D., GIL ROTER, M.D., SCOTT M. ANDES, D.O., LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-531-3703
Mailing Address - Street 1:7001 AVENUE U
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6117
Mailing Address - Country:US
Mailing Address - Phone:718-531-3703
Mailing Address - Fax:718-531-5945
Practice Address - Street 1:7001 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-6117
Practice Address - Country:US
Practice Address - Phone:718-531-3703
Practice Address - Fax:718-531-5945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WEE1G1Medicare PIN