Provider Demographics
NPI:1215087010
Name:POMERANTZ, JEFFERY M (PHD)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:M
Last Name:POMERANTZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:15 HARMONY RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2315
Mailing Address - Country:US
Mailing Address - Phone:631-462-0994
Mailing Address - Fax:631-730-4842
Practice Address - Street 1:35 CROOKED HILL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5415
Practice Address - Country:US
Practice Address - Phone:631-462-0994
Practice Address - Fax:631-730-4842
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7390103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent