Provider Demographics
NPI:1760414700
Name:STYLMAN, JAY I (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:I
Last Name:STYLMAN
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 1:847 KEARNY AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-3209
Mailing Address - Country:US
Mailing Address - Phone:201-991-0041
Mailing Address - Fax:201-991-5305
Practice Address - Street 1:847 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-3209
Practice Address - Country:US
Practice Address - Phone:201-991-0041
Practice Address - Fax:201-991-5305
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA52191208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0272205Medicaid
NJST536455Medicare ID - Type Unspecified
NJC56894Medicare UPIN