Provider Demographics
NPI:1932893542
Name:BANISH, JAY EDWARD (ABO)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:EDWARD
Last Name:BANISH
Suffix:
Gender:M
Credentials:ABO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 TRINITY POINT DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-2974
Mailing Address - Country:US
Mailing Address - Phone:724-229-7769
Mailing Address - Fax:724-229-7792
Practice Address - Street 1:30 TRINITY POINT DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-2974
Practice Address - Country:US
Practice Address - Phone:724-229-7769
Practice Address - Fax:724-229-7792
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA031002156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician