Provider Demographics
NPI:1053483164
Name:JAY M PURVIN, DPM
Entity Type:Organization
Organization Name:JAY M PURVIN, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PURVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-489-1950
Mailing Address - Street 1:336 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-2714
Mailing Address - Country:US
Mailing Address - Phone:516-489-1950
Mailing Address - Fax:516-489-6861
Practice Address - Street 1:336 CEDAR LN
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2714
Practice Address - Country:US
Practice Address - Phone:516-489-1950
Practice Address - Fax:516-489-6861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNO029711213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY040426008382OtherFIDELIS
NYAS1651OtherOXFORD
NY0028525OtherGHI
NY00406217Medicaid
NJ0758507Medicaid
NY1161608OtherHORIZON
NYN02971-A13OtherHEALTHFIRST
NY303916OtherUNITED HEALTHCARE
NY6283312-006OtherCIGNA
NY442480195OtherRAILROAD MEDICARE
NY1C1904OtherHEALTHNET
NY36608POtherHIP
NY4514751OtherAETNA
NY4514751OtherAETNA
NY1128690001Medicare NSC
NY6283312-006OtherCIGNA
NY00406217Medicaid
NJ012735Medicare PIN