Provider Demographics
NPI:1548328586
Name:POPPERS, JEREMY SAMUEL (MD PHD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:SAMUEL
Last Name:POPPERS
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Gender:M
Credentials:MD PHD
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Mailing Address - Street 1:PO BOX 1554
Mailing Address - Street 2:HEALTH SCIENCE CENTER LEVEL 4, # 060
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0988
Mailing Address - Country:US
Mailing Address - Phone:631-444-2975
Mailing Address - Fax:631-444-2907
Practice Address - Street 1:101 NICOLLS RD
Practice Address - Street 2:HEALTH SCIENCE CENTER LEVEL 4, # 060
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-2975
Practice Address - Fax:631-444-2907
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2015-07-06
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Provider Licenses
StateLicense IDTaxonomies
MA225604207L00000X
NY252463-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology