Provider Demographics
NPI:1013220706
Name:JEREMIAH S REDSTONE, M.D., P.C.
Entity Type:Organization
Organization Name:JEREMIAH S REDSTONE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:STAR
Authorized Official - Last Name:REDSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-509-8547
Mailing Address - Street 1:212 WARREN ST
Mailing Address - Street 2:11N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10282-5802
Mailing Address - Country:US
Mailing Address - Phone:646-509-8547
Mailing Address - Fax:
Practice Address - Street 1:45 E 85TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0957
Practice Address - Country:US
Practice Address - Phone:212-249-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100031584OtherPTAN