Provider Demographics
NPI:1902943129
Name:COLLEY, JEREMY HUSTON (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:HUSTON
Last Name:COLLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:841 BROADWAY
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4704
Mailing Address - Country:US
Mailing Address - Phone:888-544-9215
Mailing Address - Fax:212-677-2285
Practice Address - Street 1:841 BROADWAY
Practice Address - Street 2:SUITE 302
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4704
Practice Address - Country:US
Practice Address - Phone:888-544-9215
Practice Address - Fax:212-677-2285
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2308542084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry