Healthcare Provider Details

I. General information

NPI: 1275920720
Provider Name (Legal Business Name): JEFFREY DEYGOO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 MADISON AVE STE 203
NEW YORK NY
10017-6308
US

IV. Provider business mailing address

1117 ROUTE 46 STE 205
CLIFTON NJ
07013-2450
US

V. Phone/Fax

Practice location:
  • Phone: 855-637-1915
  • Fax:
Mailing address:
  • Phone:
  • Fax: 620-679-1997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number305111
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number25MA10858500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: