Provider Demographics
NPI:1487670105
Name:STARR, JAY I (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:I
Last Name:STARR
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 1:1755 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-5207
Mailing Address - Country:US
Mailing Address - Phone:631-667-0388
Mailing Address - Fax:631-254-3028
Practice Address - Street 1:1755 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-5207
Practice Address - Country:US
Practice Address - Phone:631-667-0388
Practice Address - Fax:631-254-3028
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNY134036207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD84678Medicare ID - Type Unspecified
NYD84678Medicare UPIN