Provider Demographics
NPI:1740395177
Name:LOVELY, JAY SCOTT (C PED)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:SCOTT
Last Name:LOVELY
Suffix:
Gender:M
Credentials:C PED
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Mailing Address - Street 1:1372 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-7445
Mailing Address - Country:US
Mailing Address - Phone:718-828-8344
Mailing Address - Fax:718-281-1913
Practice Address - Street 1:1372 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-7445
Practice Address - Country:US
Practice Address - Phone:718-828-8344
Practice Address - Fax:718-281-1913
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN3010998213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist