Provider Demographics
NPI:1386646305
Name:COLE, JEFFREY LEWIS (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LEWIS
Last Name:COLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 WIMBLETON LN
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1347
Mailing Address - Country:US
Mailing Address - Phone:516-487-1648
Mailing Address - Fax:516-482-7253
Practice Address - Street 1:10615 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4365
Practice Address - Country:US
Practice Address - Phone:718-261-6366
Practice Address - Fax:718-263-3427
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1416122081P2900X
NJ25MA079543002081P2900X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC04491Medicare UPIN
NY89384Medicare ID - Type Unspecified