Provider Demographics
NPI:1649583808
Name:DINOVITSER, JAY DANIEL (DO)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:DANIEL
Last Name:DINOVITSER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:DINOVITSER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 201
Mailing Address - Street 2:
Mailing Address - City:SOUTH FALLSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12779-0201
Mailing Address - Country:US
Mailing Address - Phone:845-798-5244
Mailing Address - Fax:866-788-0859
Practice Address - Street 1:29 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ELLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12428-1082
Practice Address - Country:US
Practice Address - Phone:845-798-5244
Practice Address - Fax:866-788-0859
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015281207R00000X
NY262529207R00000X
NJ25MB09015800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine