Provider Demographics
NPI:1770568974
Name:APPELBAUM, JEFFREY CHARLES (DO)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:CHARLES
Last Name:APPELBAUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5907 175TH PL
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1551
Mailing Address - Country:US
Mailing Address - Phone:718-939-0800
Mailing Address - Fax:718-939-1325
Practice Address - Street 1:5907 175TH PL
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11365-1551
Practice Address - Country:US
Practice Address - Phone:718-939-0800
Practice Address - Fax:718-939-1325
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1348752084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00580429Medicaid
NY00580429Medicaid
D79303Medicare UPIN