Provider Demographics
NPI:1639234594
Name:GREENSPAN, JAY S (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:S
Last Name:GREENSPAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:THOMAS JEFFERSON UNIVERSITY HOSPITAL
Practice Address - Street 2:111 S. 11TH STREET
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4824
Practice Address - Country:US
Practice Address - Phone:215-955-6000
Practice Address - Fax:215-923-9519
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD032008E2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2401509Medicaid
PA1124586Medicaid
MD7301111Medicaid
C31230Medicare UPIN
PA1124586Medicaid
MD7301111Medicaid