Provider Demographics
NPI:1912913195
Name:JEFFERS, VANESSA L (MD)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:L
Last Name:JEFFERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 LAFAYETTE AVE
Mailing Address - Street 2:STE #1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-6409
Mailing Address - Country:US
Mailing Address - Phone:718-789-2322
Mailing Address - Fax:
Practice Address - Street 1:55 GREENE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238
Practice Address - Country:US
Practice Address - Phone:718-789-2322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184938207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01490793Medicaid
NY06H691Medicare PIN
F66828Medicare UPIN