Provider Demographics
NPI:1588601207
Name:DRAOUA, JAY D (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:D
Last Name:DRAOUA
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 1:2164 CROMPOND ROAD
Mailing Address - Street 2:
Mailing Address - City:YORKTWON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-3700
Mailing Address - Country:US
Mailing Address - Phone:914-393-8023
Mailing Address - Fax:
Practice Address - Street 1:2164 CROMPOND ROAD
Practice Address - Street 2:
Practice Address - City:YORKTWON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-3700
Practice Address - Country:US
Practice Address - Phone:914-393-8023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2208442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02148589Medicaid
NY02148589Medicaid
NY711R806261Medicare PIN
NYA400098686Medicare PIN