Basic Information
| Provider Information | |||||||||
| NPI: | 1750321626 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAYER | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 EAST MAIN STREET | ||||||||
| Address2: | NORTHERN WESTCHESTER HOSPITAL ATTN: MEDICAL AFFAIRS OFF | ||||||||
| City: | MT KISCO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146661254 | ||||||||
| FaxNumber: | 9146661965 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 EAST MAIN STREET | ||||||||
| Address2: | NORTHERN WESTCHESTER HOSPITAL EMERGENCY ROOM | ||||||||
| City: | MT KISCO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146661254 | ||||||||
| FaxNumber: | 9146661931 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 05/02/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 217698 | NY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000106123 | 01 | NY | GHI HMO PIN# | OTHER | 060707000001 | 01 | NY | FIDELIS CARE OF NY PIN # | OTHER | 1082049 | 01 | AETNA HMO | OTHER | 2288Q1 | 01 | BCBS | OTHER | 2154190 | 01 | UNITED HEALTHCARE PIN # | OTHER | 4147739 | 01 | MVP | OTHER | P3650590 | 01 | OXFORD HEALTH PLAN PIN # | OTHER | 10087294 | 01 | CDPHP PIN# | OTHER | 1082049 | 01 | AETNA HMO PIN # | OTHER | 7033196 | 01 | AETNA PPO | OTHER | 0112699 | 01 | NY | GHI PPO | OTHER | 5C4627 | 01 | HEALTHNET PIN # | OTHER |