Provider Demographics
NPI:1083691240
Name:DALY, JAY M (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:M
Last Name:DALY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:215 TOLL GATE RD
Mailing Address - Street 2:STE 109
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4458
Mailing Address - Country:US
Mailing Address - Phone:401-738-3100
Mailing Address - Fax:401-738-8505
Practice Address - Street 1:1729 BURRSTONE RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-1001
Practice Address - Country:US
Practice Address - Phone:315-798-1440
Practice Address - Fax:315-624-2135
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2017-09-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2739502085R0202X
MA554542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03802242Medicaid
NY03802242Medicaid
MAP00620503OtherRR MEDICARE
F07843Medicare UPIN