Provider Demographics
NPI:1447522552
Name:JEROME, JEFFREY JOSEPH (FNP)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:JOSEPH
Last Name:JEROME
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3417
Mailing Address - Country:US
Mailing Address - Phone:631-661-2277
Mailing Address - Fax:631-669-2190
Practice Address - Street 1:350 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3417
Practice Address - Country:US
Practice Address - Phone:631-661-2277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY626452163W00000X
NYF340770-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse