Provider Demographics
NPI:1649251885
Name:MEHLMAN, JAY KENNETH (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:KENNETH
Last Name:MEHLMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:12105 ROCKAWAY BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLE HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1821
Mailing Address - Country:US
Mailing Address - Phone:718-318-0800
Mailing Address - Fax:718-318-0440
Practice Address - Street 1:949 NORTHFIELD RD
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1663
Practice Address - Country:US
Practice Address - Phone:718-318-0800
Practice Address - Fax:718-318-0440
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY201048207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02115704Medicaid
NY02115704Medicaid
NYH12248Medicare UPIN
113577139OtherTAX ID NUMBER