Healthcare Provider Details

I. General information

NPI: 1912775115
Provider Name (Legal Business Name): JEFFREY A VERNON, DO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 SPRING ST
SENECA FALLS NY
13148-2021
US

IV. Provider business mailing address

1 W 4TH ST APT 1406
CINCINNATI OH
45202-3856
US

V. Phone/Fax

Practice location:
  • Phone: 917-725-0762
  • Fax: 905-963-1689
Mailing address:
  • Phone: 917-725-0762
  • Fax: 905-963-1689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY A. VERNON
Title or Position: MEMBER
Credential: DO
Phone: 917-725-0762