MEDICARE: JAY PROSNITZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	49077	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134130081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY PROSNITZ M.D.

Provider Business Mailing Address
First Line	:	9 INDUSTRIAL RD
Second Line	:	SUITE 5
City	:	MILFORD
State	:	MA
Zip	:	01757-3588
Country	:	US
Telephone Number	:	508-473-1480
Fax Number	:	508-473-1210

Provider Business Practice Location Address
First Line	:	100 MEDWAY RD
Second Line	:	SUITE 101
City	:	MILFORD
State	:	MA
Zip	:	01757-2923
Country	:	US
Telephone Number	:	508-482-5425
Fax Number	:	508-482-5430

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	10/06/2011

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