Individual
DR. ELISE W VAN DER JAGT
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
601 ELMWOOD AVE, BOX 635, ROCHESTER, NY 14642-0001
(585) 275-8138
(585) 275-2352
Mailing address
601 ELMWOOD AVE, BOX 635, ROCHESTER, NY 14642-0001
(585) 275-8138
(585) 275-2352
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
124938
NY
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
124938
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00512863
—
NY
Enumeration date
06/21/2006
Last updated
09/11/2025
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