Provider Demographics
NPI:1396734570
Name:SCHNITZER, JAY JEFFREY (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:JEFFREY
Last Name:SCHNITZER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS. GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:PEDIATRIC SURGERY, WRN 11
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-1602
Practice Address - Fax:617-726-2167
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA59597208600000X, 2086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4247402OtherAETNA
MAJ09199OtherBCBS MA
MA1740084OtherUNITED-PBO
MA3049337Medicaid
MA4151497-004OtherCIGNA PAL
MAE28419157MGHOtherHPHC-PBO
MAE28419MGHOtherHPHC-ACD
MA728264OtherTUFTS HEALTH PLAN
MA1740084OtherUNITED-PBO
MA728264OtherTUFTS HEALTH PLAN