Provider Demographics
NPI:1215942784
Name:JAE, GINA A (MD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:A
Last Name:JAE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:271 W 11TH ST
Mailing Address - Street 2:#2B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-2425
Mailing Address - Country:US
Mailing Address - Phone:917-319-1395
Mailing Address - Fax:917-722-0561
Practice Address - Street 1:271 W 11TH ST
Practice Address - Street 2:#2B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-2425
Practice Address - Country:US
Practice Address - Phone:917-319-1395
Practice Address - Fax:917-722-0561
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY230334207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics