Healthcare Provider Details

I. General information

NPI: 1477050862
Provider Name (Legal Business Name): JEREMY PAUL ADER MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 1ST AVE BLDG 10W13
NEW YORK NY
10016-9196
US

IV. Provider business mailing address

462 1ST AVE BLDG 10W13
NEW YORK NY
10016-9196
US

V. Phone/Fax

Practice location:
  • Phone: 212-562-4141
  • Fax:
Mailing address:
  • Phone: 212-562-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number308344-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME177025
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMED-PHYS-LIC-161238
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: