Provider Demographics
NPI:1295074862
Name:CEDARBAUM, JESSE M (MD)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:M
Last Name:CEDARBAUM
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16 OLD BARNABAS RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-1923
Mailing Address - Country:US
Mailing Address - Phone:203-389-3323
Mailing Address - Fax:203-389-3336
Practice Address - Street 1:16 OLD BARNABAS RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-1923
Practice Address - Country:US
Practice Address - Phone:203-389-3323
Practice Address - Fax:203-389-3336
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-02
Last Update Date:2013-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1421552084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology