Provider Demographics
NPI:1437289451
Name:DR JAY R NEWMAN PA
Entity Type:Organization
Organization Name:DR JAY R NEWMAN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:R
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-638-7600
Mailing Address - Street 1:15340 JOG ROAD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-0000
Mailing Address - Country:US
Mailing Address - Phone:561-638-7600
Mailing Address - Fax:561-638-6787
Practice Address - Street 1:15340 JOG RD
Practice Address - Street 2:STE 205
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2131213E00000X
FLPO 2131213EP1101X, 213ER0200X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiologyGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34882OtherBCBS OF FL GRP #
FL340387400Medicaid
481117394OtherTRIWEST
FL34882OtherBCBS OF FL GRP #
FL340387400Medicaid