Provider Demographics
NPI:1255485330
Name:MEYER, JEROME (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:MEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CAMBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1306
Mailing Address - Country:US
Mailing Address - Phone:845-709-2438
Mailing Address - Fax:845-354-3733
Practice Address - Street 1:3 CAMBRIDGE RD
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-1306
Practice Address - Country:US
Practice Address - Phone:845-709-2438
Practice Address - Fax:845-354-3733
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1120211207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B79596Medicare UPIN
NY81A591Medicare ID - Type Unspecified
NY81A591Medicare ID - Type Unspecified