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General NPI Number Information
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NPI Number | 1275920720
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Entity Type | Individual
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Provider Name | JEFFREY DEYGOO M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/22/2015
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 290 MADISON AVE STE 203
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City | NEW YORK
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State | NY
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Zip | 10017-6308
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Country | US
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Telephone | 855-637-1915
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Fax |
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Provider Business Mailing Address
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Address Line | 1117 ROUTE 46 STE 205
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City | CLIFTON
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State | NJ
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Zip | 07013-2450
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Country | US
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Telephone |
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Fax | 620-679-1997
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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 | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 305111
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 25MA10858500
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License Number State | NJ
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