Provider Demographics
NPI:1689754418
Name:DEMESQUITA, JAY (OD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:
Last Name:DEMESQUITA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4222 WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08110-3010
Mailing Address - Country:US
Mailing Address - Phone:856-964-1058
Mailing Address - Fax:856-662-0299
Practice Address - Street 1:4222 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08110-3010
Practice Address - Country:US
Practice Address - Phone:856-964-1058
Practice Address - Fax:856-662-0299
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00367000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1373501Medicaid
NJ0K9077OtherHEALTH NET MATERIALS
NJF09873OtherHEALTH NET
NJ18220OtherSPECTERA/AMERICHOICE
NJ33221OtherAETNA
NJNJ03620OtherVISION BENEFITS OF AMERIC
NJ310045OtherNATL VISION ADMINISTRATOR
NJF09873OtherHEALTH NET
NJ33221OtherAETNA
NJ124332Medicare ID - Type UnspecifiedMEDICARE