Provider Demographics
NPI:1629114731
Name:JAEGER, ROBERTA D (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:D
Last Name:JAEGER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:963 HASTINGS ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4737
Mailing Address - Country:US
Mailing Address - Phone:508-395-7938
Mailing Address - Fax:
Practice Address - Street 1:269 FULTON AVE
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3947
Practice Address - Country:US
Practice Address - Phone:516-537-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2348111N00000X
NY009261111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2554325OtherAETNA HEALTH PLAN
MA0027885OtherNEIGHBORHOOD HEALTH PLAN
MA1601067Medicaid
MA468521OtherTUFTS HEALTH PLAN
MAY36673OtherBCBS OF MASSACHUSETTS
MA97718801OtherNETWORK HEALTH
MA352291OtherHARVARD PLIGRIM HEALTH PL
MA352291OtherHARVARD PLIGRIM HEALTH PL