Provider Demographics
NPI:1932106499
Name:BROOKS, JEFFREY S (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:BROOKS
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 1:70 HATFIELD LN
Mailing Address - Street 2:STE 204
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-6735
Mailing Address - Country:US
Mailing Address - Phone:914-456-7599
Mailing Address - Fax:845-294-2312
Practice Address - Street 1:70 HATFIELD LN
Practice Address - Street 2:STE 204
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6735
Practice Address - Country:US
Practice Address - Phone:914-456-7599
Practice Address - Fax:845-294-2312
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147287207RG0100X
ND10169207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00915242Medicaid
NY00915242Medicaid
44D051Medicare ID - Type Unspecified