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NPI Code Detail

MEDICARE: DR. JEREMY M VEENSTRA-VANDERWEELE MD

MEDICARE: DR. JEREMY M VEENSTRA-VANDERWEELE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0804XChild & Adolescent Psychiatry Physician60275293NY

General Provider Information

NPI Number : 1164451324
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEREMY M VEENSTRA-VANDERWEELE MD
Provider Business Mailing Address
First Line : 1051 RIVERSIDE DR UNIT 78
Second Line :
City : NEW YORK
State : NY
Zip : 10032-1007
Country : US
Telephone Number : 646-774-5251
Fax Number :
Provider Business Practice Location Address
First Line : 3 COLUMBUS CIR STE 1425
Second Line :
City : NEW YORK
State : NY
Zip : 10019-8720
Country : US
Telephone Number : 212-342-3800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2006
Last Update Date : 07/24/2020

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