Healthcare Provider Details

I. General information

NPI: 1093247926
Provider Name (Legal Business Name): TREMAINE JAMAR WRIGHT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 WADSWORTH AVE
NEW YORK NY
10033
US

IV. Provider business mailing address

801 NEILL AVE APT 24D
BRONX NY
10462-3026
US

V. Phone/Fax

Practice location:
  • Phone: 212-866-3096
  • Fax:
Mailing address:
  • Phone: 251-599-2388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number303084
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number303084
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: