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NPI Code Detail

MEDICARE: DR. JEREMIAH EDILLOR JUSON DMD

MEDICARE: DR. JEREMIAH EDILLOR JUSON DMD
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
1122300000XDentistDL11820MA
21223X0400XOrthodontics and Dentofacial Orthopedics DentistryDL11820MA
31223X0400XOrthodontics and Dentofacial Orthopedics Dentistry059613NY

General Provider Information

NPI Number : 1265766315
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEREMIAH EDILLOR JUSON DMD
Provider Business Mailing Address
First Line : 360 E 89TH ST APT 5B
Second Line :
City : NEW YORK
State : NY
Zip : 10128-5418
Country : US
Telephone Number : 212-803-3345
Fax Number :
Provider Business Practice Location Address
First Line : 2301 QUEENS PLZ N STE C
Second Line :
City : LONG ISLAND CITY
State : NY
Zip : 11101
Country : US
Telephone Number : 508-679-8111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2009
Last Update Date : 03/07/2023

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