MEDICARE: DR. ERIC LOUIS JEROME 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
1	207RN0300X	Nephrology Physician	147460	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841216330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC LOUIS JEROME M.D

Provider Business Mailing Address
First Line	:	1166 EASTERN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11213-4108
Country	:	US
Telephone Number	:	718-771-6133
Fax Number	:	718-771-6001

Provider Business Practice Location Address
First Line	:	1166 EASTERN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11213-4108
Country	:	US
Telephone Number	:	718-771-6133
Fax Number	:	718-771-6001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	09/18/2019

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