Provider Demographics
NPI:1962470906
Name:DENNETT, JAY
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:
Last Name:DENNETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 E 85TH ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0412
Mailing Address - Country:US
Mailing Address - Phone:212-545-8506
Mailing Address - Fax:212-685-5166
Practice Address - Street 1:10 E 85TH ST STE 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0412
Practice Address - Country:US
Practice Address - Phone:212-545-8506
Practice Address - Fax:212-685-5166
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182755207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY457945OtherAETNA/ US HEATHCARE
NYNS1955OtherOXFORD
NY113028415OtherTAX ID #
NYF27839Medicare UPIN
NY457945OtherAETNA/ US HEATHCARE
NY63F022Medicare ID - Type Unspecified