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Individual

JACLYN FALLON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
171 RAMAPO RD, GARNERVILLE, NY 10923-1552
(845) 947-1772
(845) 947-4487
Mailing address
22 SAW MILL RIVER RD, 2ND FLOOR, HAWTHORNE, NY 10532-1533
(845) 947-1772
(845) 947-4487

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
264124
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
03464413
NY
Enumeration date
03/27/2009
Last updated
07/23/2013
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