Provider Demographics
NPI:1235323171
Name:PARKINSON, JAY DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:DANIEL
Last Name:PARKINSON
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 1:459 KEAP ST
Mailing Address - Street 2:APT #3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-3433
Mailing Address - Country:US
Mailing Address - Phone:917-753-0751
Mailing Address - Fax:
Practice Address - Street 1:459 KEAP ST
Practice Address - Street 2:APT #3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-3433
Practice Address - Country:US
Practice Address - Phone:917-753-0751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245865208000000X, 2083P0901X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine