Provider Demographics
NPI:1508854837
Name:STOCKMAN, JAY B (OD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:B
Last Name:STOCKMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 MADISON AVE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4325
Mailing Address - Country:US
Mailing Address - Phone:212-213-3737
Mailing Address - Fax:212-213-3787
Practice Address - Street 1:185 MADISON AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4325
Practice Address - Country:US
Practice Address - Phone:212-213-3737
Practice Address - Fax:212-213-3787
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT4199152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC29761Medicare ID - Type Unspecified
T81497Medicare UPIN