Provider Demographics
NPI:1275625261
Name:JEREMIN, PETER J (DPM)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:JEREMIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 BORDENTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859-1851
Mailing Address - Country:US
Mailing Address - Phone:732-721-6553
Mailing Address - Fax:
Practice Address - Street 1:1145 BORDENTOWN AVE
Practice Address - Street 2:
Practice Address - City:PARLIN
Practice Address - State:NJ
Practice Address - Zip Code:08859-1851
Practice Address - Country:US
Practice Address - Phone:732-721-6553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00125000213E00000X, 213ER0200X, 213ES0000X, 213ES0131X
NJ25MD0025000213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0810850001Medicare NSC
NJ196898Medicare PIN
NJT44698Medicare UPIN