Provider Demographics
NPI:1740235993
Name:JERET, JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:JERET
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 1:220 MAPLE AVENUE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROCKVILLE CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:11570
Mailing Address - Country:US
Mailing Address - Phone:516-593-5800
Mailing Address - Fax:516-593-4752
Practice Address - Street 1:220 MAPLE AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCKVILLE CENTER
Practice Address - State:NY
Practice Address - Zip Code:11570
Practice Address - Country:US
Practice Address - Phone:516-593-5800
Practice Address - Fax:516-593-4752
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17865812084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAS693OtherOXFORD
NY01526205Medicaid
NY549250OtherAETNA
F43825Medicare UPIN
NY08L781Medicare PIN