Provider Demographics
NPI:1497710388
Name:COWEN, JAY S (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:S
Last Name:COWEN
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:DEPT 4392
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-0001
Mailing Address - Country:US
Mailing Address - Phone:866-540-5303
Mailing Address - Fax:
Practice Address - Street 1:750 W 800 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-3660
Practice Address - Country:US
Practice Address - Phone:801-783-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044182L207RC0200X
IL036100737207RP1001X
UT11467514-1205208M00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036100737OtherBLUE CROSS BLUE SHIELD
IL0361007372Medicaid
PA0695176000OtherINDEPENDENCE BLUE CROSS
PA30019159OtherKEYSTONE MERCY
PA752958OtherHIGHMARK BLUE SHIELD
PA0014579300005Medicaid
PA145793001OtherAMERICHOICE
PA34928MD044182LOtherHEALTH PARTNERS
ILK20007Medicare PIN
PA30019159OtherKEYSTONE MERCY
ILL85591Medicare ID - Type Unspecified
IL0361007372Medicaid