Provider Demographics
NPI:1598822736
Name:WINELL, JEREMY MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:MICHAEL
Last Name:WINELL
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 1:80 8TH AVE
Mailing Address - Street 2:STE 1303
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7161
Mailing Address - Country:US
Mailing Address - Phone:917-805-5002
Mailing Address - Fax:
Practice Address - Street 1:80 8TH AVE
Practice Address - Street 2:STE 1303
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7161
Practice Address - Country:US
Practice Address - Phone:917-805-5002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2278612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02724312Medicaid
NY02724312Medicaid
NY545BY1Medicare ID - Type Unspecified