Provider Demographics
NPI:1063759777
Name:SHERWOOD, JEFFREY MARC (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MARC
Last Name:SHERWOOD
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:33 FLYING POINT RD
Mailing Address - Street 2:SUITE 123
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-5248
Mailing Address - Country:US
Mailing Address - Phone:631-287-9696
Mailing Address - Fax:631-726-9323
Practice Address - Street 1:33 FLYING POINT RD
Practice Address - Street 2:SUITE 123
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-5248
Practice Address - Country:US
Practice Address - Phone:631-287-9696
Practice Address - Fax:631-726-9323
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY107177208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery