Provider Demographics
NPI:1841216330
Name:JEROME, ERIC LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:LOUIS
Last Name:JEROME
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1166 EASTERN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-4108
Mailing Address - Country:US
Mailing Address - Phone:718-771-6133
Mailing Address - Fax:718-771-6001
Practice Address - Street 1:1166 EASTERN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-4108
Practice Address - Country:US
Practice Address - Phone:718-771-6133
Practice Address - Fax:718-771-6001
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147460207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00875796Medicaid
NY00875796Medicaid