Provider Demographics
NPI:1265504211
Name:DUVINSKY, JERRY DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:DAVID
Last Name:DUVINSKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 VALLEY PLZ
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-1009
Mailing Address - Country:US
Mailing Address - Phone:607-797-1100
Mailing Address - Fax:607-797-9514
Practice Address - Street 1:804 VALLEY PLZ
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1009
Practice Address - Country:US
Practice Address - Phone:607-797-1100
Practice Address - Fax:607-797-9514
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0103631103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01409512Medicaid
NY52559BMedicare ID - Type Unspecified