Provider Demographics
NPI:1295859841
Name:JAY W ENEMAN MD, PC
Entity Type:Organization
Organization Name:JAY W ENEMAN MD, PC
Other - Org Name:BRIDGE REHABILITATION & MUSCULOSKELETAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:W
Authorized Official - Last Name:ENEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-897-9000
Mailing Address - Street 1:PO BOX 330
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-0330
Mailing Address - Country:US
Mailing Address - Phone:516-897-9000
Mailing Address - Fax:516-897-9827
Practice Address - Street 1:780 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2238
Practice Address - Country:US
Practice Address - Phone:516-897-9000
Practice Address - Fax:516-897-9827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1325802251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00492526Medicaid
NY4093200002Medicare NSC
81P783Medicare PIN