Provider Demographics
NPI:1922114545
Name:DR JAY BORNSTEIN DPM PA
Entity Type:Organization
Organization Name:DR JAY BORNSTEIN DPM PA
Other - Org Name:BORNSTEIN PODIATRY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:B
Authorized Official - Last Name:BORNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-657-9188
Mailing Address - Street 1:3009 ALOMA AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3701
Mailing Address - Country:US
Mailing Address - Phone:407-657-9188
Mailing Address - Fax:407-677-4770
Practice Address - Street 1:3009 ALOMA AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3701
Practice Address - Country:US
Practice Address - Phone:407-657-9188
Practice Address - Fax:407-677-4770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1564213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDB3242OtherRR GROUP #
FLK5347Medicare PIN
FLDB3242OtherRR GROUP #
FL5424050001Medicare NSC