Provider Demographics
NPI:1467434126
Name:FENSTER, JAY SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:SAMUEL
Last Name:FENSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 COPPERBEECH LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-2606
Mailing Address - Country:US
Mailing Address - Phone:516-569-7367
Mailing Address - Fax:
Practice Address - Street 1:657 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2320
Practice Address - Country:US
Practice Address - Phone:516-374-0670
Practice Address - Fax:516-295-0648
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174304207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY72F91Medicare ID - Type Unspecified
E69925Medicare UPIN