Provider Demographics
NPI:1982654968
Name:CALESNICK, JAY LEE (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:LEE
Last Name:CALESNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 ROUTE 45
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NJ
Mailing Address - Zip Code:08079-2023
Mailing Address - Country:US
Mailing Address - Phone:856-935-0700
Mailing Address - Fax:856-935-8630
Practice Address - Street 1:261 ROUTE 45
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NJ
Practice Address - Zip Code:08079-2023
Practice Address - Country:US
Practice Address - Phone:856-935-0700
Practice Address - Fax:856-935-8630
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA39059207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2298601Medicaid
NJ2298601Medicaid
B19150Medicare UPIN
NJ542965Medicare ID - Type Unspecified