Provider Demographics
NPI:1508036021
Name:TOLBERT, JEROME V (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:V
Last Name:TOLBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 E 42ND ST
Mailing Address - Street 2:FL 9
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-5699
Mailing Address - Country:US
Mailing Address - Phone:212-420-4411
Mailing Address - Fax:212-420-2224
Practice Address - Street 1:317 E 17TH ST
Practice Address - Street 2:7TH FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3804
Practice Address - Country:US
Practice Address - Phone:212-844-1273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127560207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00580350Medicaid
NY29A131Medicare PIN