Provider Demographics
NPI:1912210055
Name:JAY MEDICAL PLLC
Entity Type:Organization
Organization Name:JAY MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYADEVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNDUMADATHIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-473-8974
Mailing Address - Street 1:406 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-4280
Mailing Address - Country:US
Mailing Address - Phone:321-473-8974
Mailing Address - Fax:321-473-8976
Practice Address - Street 1:406 5TH AVE
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-4280
Practice Address - Country:US
Practice Address - Phone:321-473-8974
Practice Address - Fax:321-473-8976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78547207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty