Provider Demographics
NPI:1104938455
Name:AMMIRATA, JACQUELINE A (MD)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:A
Last Name:AMMIRATA
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Gender:F
Credentials:MD
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Mailing Address - Street 1:45 RESEARCH WAY STE 105
Mailing Address - Street 2:UNIVERSITY ASSOCIATES OBGYN
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-6401
Mailing Address - Country:US
Mailing Address - Phone:631-672-8279
Mailing Address - Fax:631-350-7200
Practice Address - Street 1:320 MONTAUK HIGHWAY
Practice Address - Street 2:SOUTH BAY OB GYN PC
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4401
Practice Address - Country:US
Practice Address - Phone:631-587-2500
Practice Address - Fax:631-587-0292
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-10-14
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Provider Licenses
StateLicense IDTaxonomies
NY2060531207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01944912Medicaid
NY2507203OtherGHI
NY44G631OtherBCBS
NY44G631OtherBCBS
F41767Medicare UPIN