Individual
JERRY JACOB GEORGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
49 NESCONSET HWY, PORT JEFFERSON STATION, NY 11776-2628
(631) 751-3000
(631) 509-6559
Mailing address
1500 ROUTE 112 BLDG 4, PORT JEFFERSON STATION, NY 11776-8055
(631) 751-0000
(631) 509-6559
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
249204
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03105479
—
NY
01
—
2999511
CIGNA
NY
01
—
38Q771
EMPIRE BS
NY
01
—
9127406
AETNA
NY
Enumeration date
07/01/2008
Last updated
01/17/2020
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