Provider Demographics
NPI:1265415038
Name:GARSMAN, JAY ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:ALLEN
Last Name:GARSMAN
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 1:9705 101ST AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-2523
Mailing Address - Country:US
Mailing Address - Phone:718-848-0606
Mailing Address - Fax:
Practice Address - Street 1:9705 101ST AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-2523
Practice Address - Country:US
Practice Address - Phone:718-848-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1141662085R0202X, 2085U0001X, 261QM1200X
NJ25MA032192002085U0001X, 2085R0202X, 261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01544063Medicaid
NJ0681202Medicaid
NY01544063Medicaid
NYC52719Medicare UPIN
NJ038380Medicare ID - Type UnspecifiedJAY A. GARSMAN M.D. INDIV
NJ0681202Medicaid