Provider Demographics
NPI:1093704934
Name:JEFFRIES, EMILY LANDA (MD)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:LANDA
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 OVERLOOK RD
Mailing Address - Street 2:SUITE L06
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-3570
Mailing Address - Country:US
Mailing Address - Phone:908-522-0050
Mailing Address - Fax:908-522-6575
Practice Address - Street 1:33 OVERLOOK RD
Practice Address - Street 2:SUITE L06
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3570
Practice Address - Country:US
Practice Address - Phone:908-522-0050
Practice Address - Fax:908-522-6575
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA058739207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F91654Medicare UPIN
NJ530087PEDMedicare ID - Type Unspecified