National Provider Identifier
Elise W Van Der Jagt, MD
Elise W Van Der Jagt, MD is listed in the NPPES registry with a primary specialty of Pediatric Critical Care Medicine Physician in Rochester, NY and a listed phone number of (585) 275-8138.
Profile Overview
- NPI
- 1083650949
- Provider Type
- Individual
- Primary Specialty
- Pediatric Critical Care Medicine Physician
- Enumeration Date
- June 21, 2006
- Last Updated
- September 11, 2025
Practice Location
- 601 Elmwood Ave
- Box 635
- Rochester, NY 14642-0001
Phone: (585) 275-8138
Specialties
- Pediatric Critical Care Medicine Physician (2080P0203X)
- Pediatrics Physician (208000000X)
Full Record
- NPI
- 1083650949
- Entity Type
- Individual
- Last Name
- Van Der Jagt
- First Name
- Elise
- Middle Name
- W
- Name Prefix
- Dr.
- Credential
- MD
- Mailing Street Address
- 601 Elmwood Ave
- Mailing Address Line 2
- Box 635
- Mailing City
- Rochester
- Mailing State
- NY
- Mailing ZIP Code
- 14642-0001
- Mailing Country
- US
- Mailing Phone
- (585) 275-8138
- Mailing Fax
- (585) 275-2352
- Practice Street Address
- 601 Elmwood Ave
- Practice Address Line 2
- Box 635
- Practice City
- Rochester
- Practice State
- NY
- Practice ZIP Code
- 14642-0001
- Practice Country
- US
- Practice Phone
- (585) 275-8138
- Practice Fax
- (585) 275-2352
- Enumeration Date
- June 21, 2006
- Last Updated
- September 11, 2025
- Sex
- Male
- Sole Proprietor
- X
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Pediatric Critical Care Medicine Physician (2080P0203X), Pediatrics Physician (208000000X)
- Other Identifiers
- 00512863 (NY)