Provider Demographics
NPI:1093797003
Name:NOVETSKY, JAY I (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:I
Last Name:NOVETSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:44650 DELCO BLVD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-1024
Mailing Address - Country:US
Mailing Address - Phone:586-254-1770
Mailing Address - Fax:586-254-3515
Practice Address - Street 1:44650 DELCO BLVD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1024
Practice Address - Country:US
Practice Address - Phone:586-254-1770
Practice Address - Fax:586-254-3515
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI042263207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3013728Medicaid
MI0500418OtherBCBSM
MIB47558Medicare UPIN
MI3013728Medicaid