Provider Demographics
NPI:1174641336
Name:IZES, JAY MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:MARTIN
Last Name:IZES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:967 N BROADWAY
Mailing Address - Street 2:ROOM 101
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1301
Mailing Address - Country:US
Mailing Address - Phone:914-964-4965
Mailing Address - Fax:914-964-4556
Practice Address - Street 1:967 N BROADWAY
Practice Address - Street 2:ROOM 101
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1301
Practice Address - Country:US
Practice Address - Phone:914-964-4965
Practice Address - Fax:914-964-4556
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1142292080A0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB13059Medicare UPIN