Provider Demographics
NPI:1932139813
Name:EFRAN, JAY S (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:S
Last Name:EFRAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E GOWEN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1022
Mailing Address - Country:US
Mailing Address - Phone:215-242-4234
Mailing Address - Fax:215-242-4674
Practice Address - Street 1:310 E GOWEN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1022
Practice Address - Country:US
Practice Address - Phone:215-242-4234
Practice Address - Fax:215-242-4674
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS000317L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAR05618Medicare UPIN