Provider Demographics
NPI:1245325026
Name:STACK, JAY IRVING (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:IRVING
Last Name:STACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2 FRANKLIN PL
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5305
Mailing Address - Country:US
Mailing Address - Phone:973-267-7673
Mailing Address - Fax:973-267-3270
Practice Address - Street 1:95 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6092
Practice Address - Country:US
Practice Address - Phone:973-775-5151
Practice Address - Fax:908-673-7336
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2017-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA03875700207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ244970602Medicaid
NJ244970602Medicaid
D97088Medicare UPIN