NPIMap

Individual provider Active NPI

Lawrence D Jaeger Sr., DO

  • Dermatology Physician
  • New York, NY
National Provider Identifier
1093711897
Registry record updated Dec 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
186814 Issued in NY
Practice address
200 Central Park S
Ste 107
New York, NY 10019
Phone
(212) 262-2500
Fax
(212) 246-0890
NPI assigned
Jun 27, 2005
Last updated
Dec 10, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 10, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 186814 NY Primary

Addresses

Primary practice location

200 Central Park S
Ste 107
New York, NY 10019

Mailing address

200 Central Park S
Ste 107
New York, NY 10019
Phone (212) 262-2500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050113000229 NY Practitioner - Dermatology 6406835933 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Community Medical &Dermatology Center Current Accepting new patients
Manhattan Medical, P.C. Current Accepting new patients
Howard D. Solomon, DO, PC Dermatology Past Accepting new patients

Locations

291 E 149th St
Bronx, NY 10451
Phone (718) 742-1000

200 Central Park S
Apt 107
New York, NY 10019
Phone (212) 262-2500

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: ljaeger@advderm.emadirect.md

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418169600000",
    "number": "1093711897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CENTRAL PARK S",
            "address_2": "STE 107",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10019",
            "telephone_number": "212-262-2500",
            "fax_number": "212-246-0890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 CENTRAL PARK S",
            "address_2": "STE 107",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10019",
            "telephone_number": "212-262-2500",
            "fax_number": "212-246-0890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAEGER",
        "first_name": "LAWRENCE",
        "middle_name": "D",
        "name_suffix": "Sr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-27",
        "last_updated": "2014-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NY",
            "license": "186814",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.