Provider Demographics
NPI:1154395416
Name:JEREMIAS, ELISABETH (MD)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:JEREMIAS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:45 RESEARCH WAY STE 105
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-6401
Mailing Address - Country:US
Mailing Address - Phone:631-672-8279
Mailing Address - Fax:631-675-2624
Practice Address - Street 1:23 SOUTH HOWELL AVENUE
Practice Address - Street 2:STONY BROOK EXTENDED CARE OB/GYN
Practice Address - City:CENEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720
Practice Address - Country:US
Practice Address - Phone:516-542-6880
Practice Address - Fax:516-542-5556
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2014-10-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA226258207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
494320OtherTUFTS HEALTH PLAN
MA2110580Medicaid
AA45543OtherHARVARD PILGRIM
90919OtherFALLON COMMUNITY HEALTH
J29518OtherBLUE CARE ELECT
042472266OtherPRIVATE HEALTHCARE SYSTEM
792643OtherMVP HEALTH CARE