Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 25MD00125000 | NJ |
Y | 222Z00000X | Podiatrist | 25MD00125000 | NJ |
N | 213EP1101X | Primary Podiatric Medicine | 25MD0025000 | NJ |
N | 111NR0200X | Radiology | 25MD00125000 | NJ |
N | 213ER0200X | Radiology | 25MD00125000 | NJ |
N | 2081S0010X | Sports Medicine | 25MD00125000 | NJ |
N | 213ES0000X | Sports Medicine | 25MD00125000 | NJ |
N | 213ES0131X | Foot Surgery | 25MD00125000 | NJ |
NPI | 1275625261 |
---|---|
Provider Name | Dr. Peter J Jeremin |
First Address | Parlin, NJ 08859-1851 |
Second Address | Parlin, NJ 08859-1851 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 14/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T44698 | (02) | NJ |