Provider Demographics
NPI:1558559005
Name:JAY POMERANCE MD SC
Entity Type:Organization
Organization Name:JAY POMERANCE MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:FORREST
Authorized Official - Last Name:POMERANCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-871-5770
Mailing Address - Street 1:657 E GOLF RD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4968
Mailing Address - Country:US
Mailing Address - Phone:847-871-5770
Mailing Address - Fax:847-871-5773
Practice Address - Street 1:657 E GOLF RD
Practice Address - Street 2:SUITE 309
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4968
Practice Address - Country:US
Practice Address - Phone:847-871-5770
Practice Address - Fax:847-871-5773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209292OtherMEDICARE PROVIDER NUMBER
ILF24035Medicare UPIN
ILK07597Medicare PIN