Provider Demographics
NPI:1497756324
Name:MUHLRAD, JEFFREY S (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:MUHLRAD
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:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-4047
Mailing Address - Country:US
Mailing Address - Phone:631-444-4230
Mailing Address - Fax:
Practice Address - Street 1:14 TECHNOLOGY DR
Practice Address - Street 2:SUITE 11
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-4047
Practice Address - Country:US
Practice Address - Phone:631-444-4230
Practice Address - Fax:631-444-4217
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127586207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00667529Medicaid
NY28A051Medicare PIN
NYA61793Medicare UPIN