Individual
ALLISON OLIVIA JAEKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7901 4TH AVE STE A20, BROOKLYN, NY 11209-3957
(718) 491-5800
(718) 748-2151
Mailing address
119 PARK AVE, LAKE RONKONKOMA, NY 11779-1729
(631) 557-3043
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
00000000000
NY
363A00000X
Physician Assistant
Primary
026397-01
NY
Other
Enumeration date
01/11/2021
Last updated
09/27/2022
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