Provider Demographics
NPI:1619356466
Name:BRITTO, JEREMY ANDREW (DPM,AACFAS)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:ANDREW
Last Name:BRITTO
Suffix:
Gender:M
Credentials:DPM,AACFAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 NEW HYDE PARK RD STE 312
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1214
Mailing Address - Country:US
Mailing Address - Phone:516-492-3515
Mailing Address - Fax:516-492-3516
Practice Address - Street 1:3003 NEW HYDE PARK RD STE 312
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:516-492-3515
Practice Address - Fax:516-492-3516
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0069241213ES0103X
NYN006924-1213ES0103X
NY006924213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty