Provider Demographics
NPI:1417026121
Name:NEWMAN, JAY ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:ROBERT
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15340 S JOG RD STE 205
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-2170
Mailing Address - Country:US
Mailing Address - Phone:561-638-7600
Mailing Address - Fax:561-638-6787
Practice Address - Street 1:15340 S JOG RD STE 205
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-2170
Practice Address - Country:US
Practice Address - Phone:561-638-7600
Practice Address - Fax:561-638-6787
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2131213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390218800Medicaid
65244OtherBC
FL340244400Medicaid
480032655OtherRR MCR BOYNTON
N384545OtherWELLCARE
480028775OtherRR MCR DELRAY
65244OtherBC BOYNTON
65244OtherBC BOYNTON
480028775OtherRR MCR DELRAY
480032655OtherRR MCR BOYNTON
1128040001Medicare NSC
65244BMedicare PIN