Provider Demographics
NPI:1710261086
Name:JEFFREY M EPSTEIN MD PC
Entity Type:Organization
Organization Name:JEFFREY M EPSTEIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:EPSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-669-0500
Mailing Address - Street 1:51 JOHN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-2928
Mailing Address - Country:US
Mailing Address - Phone:631-669-0500
Mailing Address - Fax:631-661-0463
Practice Address - Street 1:51 JOHN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-2928
Practice Address - Country:US
Practice Address - Phone:631-669-0500
Practice Address - Fax:631-661-0463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143892207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAG4422Medicare UPIN