Provider Demographics
NPI:1922062728
Name:NEUGARTEN, JAY MATTHEW (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:MATTHEW
Last Name:NEUGARTEN
Suffix:
Gender:M
Credentials:DDS, MD
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Other - First Name:
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Mailing Address - Street 1:2001 MARCUS AVE
Mailing Address - Street 2:STE. N-10
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1011
Mailing Address - Country:US
Mailing Address - Phone:516-775-1818
Mailing Address - Fax:516-775-0892
Practice Address - Street 1:2001 MARCUS AVE
Practice Address - Street 2:STE. N-10
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042-1011
Practice Address - Country:US
Practice Address - Phone:516-775-1818
Practice Address - Fax:516-775-0892
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY046690204E00000X, 1223S0112X
NY2183387204E00000X
NY218337174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02212444Medicaid
NY02238062Medicaid