Provider Demographics
NPI:1174720726
Name:FREDERICK, JEREMY J (MD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:J
Last Name:FREDERICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:320 E 91ST ST
Mailing Address - Street 2:APT 5FW
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-6026
Mailing Address - Country:US
Mailing Address - Phone:646-643-4556
Mailing Address - Fax:212-555-1234
Practice Address - Street 1:320 E 91ST ST
Practice Address - Street 2:APT 5FW
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-6026
Practice Address - Country:US
Practice Address - Phone:646-643-4556
Practice Address - Fax:212-555-1234
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2016-08-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY246451207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology