Healthcare Provider Details

I. General information

NPI: 1285384958
Provider Name (Legal Business Name): MOUNT CARMEL MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MARLBORO LN
YONKERS NY
10710-4409
US

IV. Provider business mailing address

5 MARLBORO LN
YONKERS NY
10710-4409
US

V. Phone/Fax

Practice location:
  • Phone: 914-602-4353
  • Fax:
Mailing address:
  • Phone: 914-602-4353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JEREESH T JOHN
Title or Position: PHYSICIAN
Credential: MD
Phone: 914-602-4353