Provider Demographics
NPI:1548617483
Name:ADLER, JEREMY ELIEZAR (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:ELIEZAR
Last Name:ADLER
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:SBUH DEPARTMENT OF PATHOLOGY
Mailing Address - Street 2:101 NICOLLS ROAD
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-7025
Mailing Address - Country:US
Mailing Address - Phone:631-444-2224
Mailing Address - Fax:631-444-3419
Practice Address - Street 1:SBUH DEPARTMENT OF PATHOLOGY
Practice Address - Street 2:101 NICOLLS ROAD
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-7025
Practice Address - Country:US
Practice Address - Phone:631-444-2224
Practice Address - Fax:631-444-3419
Is Sole Proprietor?:No
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program