Provider Demographics
NPI:1689851172
Name:REDSTONE, JEREMIAH S (MD)
Entity type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:S
Last Name:REDSTONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 WARREN ST
Mailing Address - Street 2:11N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10282-5802
Mailing Address - Country:US
Mailing Address - Phone:212-249-1500
Mailing Address - Fax:
Practice Address - Street 1:200 S ORANGE AVE STE 170
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5817
Practice Address - Country:US
Practice Address - Phone:212-249-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08738100208200000X
NY256024208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0455237Medicaid