Provider Demographics
NPI:1225076722
Name:IYPE, JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:
Last Name:IYPE
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 1:2799 ROUTE 112
Mailing Address - Street 2:SUITE #11
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763
Mailing Address - Country:US
Mailing Address - Phone:631-732-5222
Mailing Address - Fax:631-732-6222
Practice Address - Street 1:2799 ROUTE 112
Practice Address - Street 2:SUITE #11
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763
Practice Address - Country:US
Practice Address - Phone:631-732-5222
Practice Address - Fax:631-732-6222
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231749208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7662603OtherAETNA
NY6B6671OtherEMPIRE BC.BS
NY02559680Medicaid
NY6B3201Medicare ID - Type Unspecified
NY02559680Medicaid