Provider Demographics
NPI:1235384587
Name:JAY A. SEITZ, PH.D., P.C.
Entity Type:Organization
Organization Name:JAY A. SEITZ, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:917-209-9623
Mailing Address - Street 1:590 W END AVE
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1722
Mailing Address - Country:US
Mailing Address - Phone:917-209-9623
Mailing Address - Fax:212-594-2468
Practice Address - Street 1:590 W END AVE
Practice Address - Street 2:SUITE 3A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1722
Practice Address - Country:US
Practice Address - Phone:917-209-9623
Practice Address - Fax:212-594-2468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-28
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010816103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01-694-077Medicaid
NY01-694-077Medicaid