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General NPI Number Information
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NPI Number | 1669592986
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Entity Type | Individual
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Provider Name | JEREMY J EGGLESTON PHD
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Gender | Male
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 09/20/2019
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Provider Practice Location Address
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Address Line | 667 STONELEIGH AVE STE 202
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City | CARMEL
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State | NY
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Zip | 10512
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Country | US
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Telephone | 917-449-5646
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Fax |
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Provider Business Mailing Address
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Address Line | 667 STONELEIGH AVE STE 202
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City | CARMEL
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State | NY
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Zip | 10512-2455
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Country | US
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Telephone | 845-230-6105
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 021868
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License Number State | NY
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