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General NPI Number Information
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NPI Number | 1073882072
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Entity Type | Individual
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Provider Name | JEROME LOMERSON
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Gender | Male
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Dates
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Enumeration Date | 12/20/2011
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Last Update Date | 12/20/2011
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Provider Practice Location Address
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Address Line | 122 E 42ND ST SUITE 3000
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City | NEW YORK
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State | NY
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Zip | 10168-0002
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Country | US
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Telephone | 212-338-6960
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Fax |
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Provider Business Mailing Address
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Address Line | 58 SKYLINE DR
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City | CORAM
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State | NY
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Zip | 11727-3699
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Country | US
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Telephone | 631-846-3873
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State | NY
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