Provider Demographics
NPI:1003811811
Name:ENEMAN, JAY W (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:W
Last Name:ENEMAN
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:PO BOX 330
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-0330
Mailing Address - Country:US
Mailing Address - Phone:516-897-9000
Mailing Address - Fax:516-897-8656
Practice Address - Street 1:780 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2238
Practice Address - Country:US
Practice Address - Phone:516-897-9000
Practice Address - Fax:516-897-8656
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2011-06-06
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
NY132580207X00000X, 225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY81P783Medicare PIN
NYB12688Medicare UPIN
4093200002Medicare NSC