Provider Demographics
NPI:1497864185
Name:KREISMAN, JEROLD JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROLD
Middle Name:JAY
Last Name:KREISMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11477 OLDE CABIN RD
Mailing Address - Street 2:STE 200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7130
Mailing Address - Country:US
Mailing Address - Phone:314-567-5000
Mailing Address - Fax:314-567-3110
Practice Address - Street 1:11477 OLDE CABIN RD
Practice Address - Street 2:STE 200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7076
Practice Address - Country:US
Practice Address - Phone:314-567-5000
Practice Address - Fax:314-567-3110
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2010-11-10
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Provider Licenses
StateLicense IDTaxonomies
MOR66062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA10972Medicare UPIN