Provider Demographics
NPI:1447506100
Name:NEHLEBER, JEREMY SETH (DMD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:SETH
Last Name:NEHLEBER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 E 20TH ST APT 9F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-7610
Mailing Address - Country:US
Mailing Address - Phone:352-219-7337
Mailing Address - Fax:
Practice Address - Street 1:531 E 20TH ST APT 9F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7610
Practice Address - Country:US
Practice Address - Phone:352-219-7337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0553861223P0300X
FLDN183311223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics