Provider Demographics
NPI:1891798435
Name:MORITZ, JAY (DPM)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:MORITZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PEACH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1423
Mailing Address - Country:US
Mailing Address - Phone:814-459-1851
Mailing Address - Fax:814-456-0541
Practice Address - Street 1:5035 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-2013
Practice Address - Country:US
Practice Address - Phone:814-480-7789
Practice Address - Fax:814-480-7790
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004679R213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2511777Medicaid
PA4235190001OtherNATIONAL SUPPLIERS CLEARINGHOUSE
PA251754199019OtherMEDICAL MUTUAL OF OHIO
PA0018106690001Medicaid
PA856681OtherHIGHMARK BLUE CROSS BLUE SHIELD
PAU81240OtherHEALTH AMERICA
PA110294OtherUNISON HEALTH PLAN
PA480030490OtherPALMETTO GBA-RAILROAD MEDICARE
PA001810669Medicaid
NY02635005Medicaid
PA4235190002OtherNATIONAL SUPPLIERS CLEARINGHOUSE
PA5046604OtherCIGNA
PA1513547OtherGATEWAY HEALTH PLAN
PA213053OtherUPMC HEALTH PLAN
PA213053OtherUPMC HEALTH PLAN
PA110294OtherUNISON HEALTH PLAN
PA001810669Medicaid
PA040250Medicare PIN