Provider Demographics
NPI:1689659658
Name:STANLEY, JAY HAROLD (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:HAROLD
Last Name:STANLEY
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 1:3445 SADDLEBROOK LN
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3034
Mailing Address - Country:US
Mailing Address - Phone:954-349-9521
Mailing Address - Fax:
Practice Address - Street 1:1776 N PINE ISLAND RD
Practice Address - Street 2:SUITE 124
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5233
Practice Address - Country:US
Practice Address - Phone:954-417-2608
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME25911174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD60491Medicare UPIN
FL93451Medicare ID - Type Unspecified