1154395416 NPI number — ELISABETH JEREMIAS MD

Table of content: ELISABETH JEREMIAS MD (NPI 1154395416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154395416 NPI number — ELISABETH JEREMIAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JEREMIAS
Provider First Name:
ELISABETH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154395416
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 RESEARCH WAY STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST SETAUKET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11733-6401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-672-8279
Provider Business Mailing Address Fax Number:
631-675-2624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23 SOUTH HOWELL AVENUE
Provider Second Line Business Practice Location Address:
STONY BROOK EXTENDED CARE OB/GYN
Provider Business Practice Location Address City Name:
CENEREACH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-542-6880
Provider Business Practice Location Address Fax Number:
516-542-5556
Provider Enumeration Date:
02/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  226258 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 494320 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2110580 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: AA45543 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 90919 . This is a "FALLON COMMUNITY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: J29518 . This is a "BLUE CARE ELECT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 792643 . This is a "MVP HEALTH CARE" identifier . This identifiers is of the category "OTHER".




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