Provider Demographics
NPI:1982615696
Name:GREENSTEIN, JAY A (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:A
Last Name:GREENSTEIN
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 1:11309 COVENT GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-9239
Mailing Address - Country:US
Mailing Address - Phone:661-330-9294
Mailing Address - Fax:661-665-8923
Practice Address - Street 1:11309 COVENT GARDENS DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-9239
Practice Address - Country:US
Practice Address - Phone:661-330-9294
Practice Address - Fax:661-665-8923
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25998207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A259980Medicaid
CAA24664Medicare UPIN
CA00A259984Medicare PIN
CA00A259980Medicaid