Provider Demographics
NPI:1780641407
Name:POMERANCE, JAY FORREST (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:FORREST
Last Name:POMERANCE
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 1:657 E GOLF RD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4968
Mailing Address - Country:US
Mailing Address - Phone:847-781-5770
Mailing Address - Fax:847-871-5773
Practice Address - Street 1:657 E GOLF RD
Practice Address - Street 2:SUITE 309
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4968
Practice Address - Country:US
Practice Address - Phone:847-871-5770
Practice Address - Fax:847-871-5773
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090131207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04932148OtherBCBS
IL04932148OtherBCBS
IL209292Medicare ID - Type Unspecified
F24035Medicare UPIN