Provider Demographics
NPI:1003902065
Name:WEINSTEIN, JAY S (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:S
Last Name:WEINSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:450 W 33RD ST
Mailing Address - Street 2:PBS 12 TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-2603
Mailing Address - Country:US
Mailing Address - Phone:212-356-4474
Mailing Address - Fax:212-356-4608
Practice Address - Street 1:170 W 12TH ST
Practice Address - Street 2:MEDICINE/GENERAL MEDICINE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8202
Practice Address - Country:US
Practice Address - Phone:212-356-4474
Practice Address - Fax:212-356-4608
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY177580207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01282140Medicaid
NY01282140Medicaid
04G021Medicare ID - Type Unspecified