Basic Information
| Provider Information | |||||||||
| NPI: | 1255368379 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YAGER | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PHD PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5010 STATE HIGHWAY 30 STE 205 | ||||||||
| Address2: | |||||||||
| City: | AMSTERDAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120107532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188422663 | ||||||||
| FaxNumber: | 5188424861 | ||||||||
| Practice Location | |||||||||
| Address1: | 5010 STATE HIGHWAY 30 STE 205 | ||||||||
| Address2: | |||||||||
| City: | AMSTERDAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188422663 | ||||||||
| FaxNumber: | 5188424861 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 06/18/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 001519 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1255368379 | 01 | NPI - INDIVIDUAL | OTHER | MY0186646 | 01 | CO | DEA | OTHER | 1902003676 | 01 | NPI - GROUP - CNSC | OTHER |