Individual
DR. JEREMY MARTIN RIEDESEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
95 E CHAUTAUQUA ST, MAYVILLE, NY 14757-0168
(716) 753-7107
(716) 753-5367
Mailing address
103 ALLEN ST, JAMESTOWN, NY 14701-6968
(716) 338-0022
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
257766
NY
207Q00000X
Family Medicine Physician
MD437884
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03247270
—
NY
01
—
J400023488
MEDICARE- TYPE UNSPECIFIED
NY
Enumeration date
05/28/2010
Last updated
07/16/2021
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