Individual
DR. JEDAN PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
181 N BELLE MEAD RD, EAST SETAUKET, NY 11733-3495
(111) 111-1111
Mailing address
PO BOX 1559, STONY BROOK, NY 11790-0989
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
226998
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02361939
—
NY
01
—
54V391
EMPIRE BC.BS
NY
01
—
7044409
AETNA
NY
Enumeration date
06/22/2006
Last updated
07/08/2007
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