Provider Demographics
NPI:1174653794
Name:OSTERMAN, JEFFERY A (CH)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:A
Last Name:OSTERMAN
Suffix:
Gender:M
Credentials:CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W 86TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3410
Mailing Address - Country:US
Mailing Address - Phone:212-496-6809
Mailing Address - Fax:212-496-6889
Practice Address - Street 1:115 W 86TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3410
Practice Address - Country:US
Practice Address - Phone:212-496-6809
Practice Address - Fax:212-496-6889
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX002912111N00000X
NJ2166111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX16481Medicare PIN