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Individual
MR. JEROLD ALLEN DESIMONE I
Active
Individual
MR. JEROLD ALLEN DESIMONE I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
23-004244
NY
363AM0700X
Medical Physician Assistant
4244
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P019004244
EXCELLUS
NY
01
—
PA0100
PREFERRED CARE
NY
Enumeration date
07/14/2006
Last updated
07/03/2023
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