Provider Demographics
NPI:1366449449
Name:DECKER, JEROME ELLIOT (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:ELLIOT
Last Name:DECKER
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 1:8100 WESCOTT DRIVE
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4671
Mailing Address - Country:US
Mailing Address - Phone:908-782-0600
Mailing Address - Fax:908-782-7575
Practice Address - Street 1:8100 WESCOTT DRIVE
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4671
Practice Address - Country:US
Practice Address - Phone:908-782-0600
Practice Address - Fax:908-782-7575
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05983000207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF59825Medicare UPIN
NJ515300ASGMedicare PIN
NJ515300B1LOtherMEDICARE BILLING NO.