Provider Demographics
NPI:1770877953
Name:PATTERSON, JEROMY RYAN (MD)
Entity type:Individual
Prefix:DR
First Name:JEROMY
Middle Name:RYAN
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6851 JERICHO TPKE STE 150
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4462
Mailing Address - Country:US
Mailing Address - Phone:516-717-1817
Mailing Address - Fax:631-204-6446
Practice Address - Street 1:11602 QUEENS BLVD STE A
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7055
Practice Address - Country:US
Practice Address - Phone:718-301-1100
Practice Address - Fax:718-261-3893
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-05
Last Update Date:2018-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY278937208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1720357817OtherNYC SURGICAL ASSOCIATES
NY04680333Medicaid