Provider Demographics
NPI:1255478921
Name:KARTZINEL, JERROLD JAY (MD)
Entity Type:Individual
Prefix:MR
First Name:JERROLD
Middle Name:JAY
Last Name:KARTZINEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:174 MURRAY GUARD DR STE C
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3742
Mailing Address - Country:US
Mailing Address - Phone:949-398-7654
Mailing Address - Fax:949-407-6788
Practice Address - Street 1:174 MURRAY GUARD DR STE C
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3742
Practice Address - Country:US
Practice Address - Phone:949-398-7654
Practice Address - Fax:949-407-6788
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84196208000000X, 2080P0008X
TN64773208000000X
FL467512080P0008X
TXME 804362080P0008X
FL80436208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
F57542Medicare UPIN