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NPI Code Detail

MEDICARE: JEREMY M O'CONNOR M.D.

MEDICARE: JEREMY M O'CONNOR M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician272463NY
2207R00000XInternal Medicine Physician55573CT
3207R00000XInternal Medicine Physician125062580IL
4207R00000XInternal Medicine Physician292463NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
155573OTHERCTCT LICENSE NUMBER

General Provider Information

NPI Number : 1164860961
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEREMY M O'CONNOR M.D.
Provider Business Mailing Address
First Line : 1225 GERARD AVE
Second Line :
City : BRONX
State : NY
Zip : 10452-8015
Country : US
Telephone Number : 718-960-2777
Fax Number :
Provider Business Practice Location Address
First Line : 1225 GERARD AVE
Second Line :
City : BRONX
State : NY
Zip : 10452-8015
Country : US
Telephone Number : 718-960-2777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2013
Last Update Date : 05/03/2021

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