Provider Demographics
NPI:1144208695
Name:ROSENFELD, JAY E (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:E
Last Name:ROSENFELD
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 2540
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02331-2540
Mailing Address - Country:US
Mailing Address - Phone:781-934-6138
Mailing Address - Fax:781-934-9082
Practice Address - Street 1:311 SERVICE ROAD
Practice Address - Street 2:
Practice Address - City:EAST SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563-1370
Practice Address - Country:US
Practice Address - Phone:508-833-4000
Practice Address - Fax:508-833-4202
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA817962081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAG06318Medicare UPIN