Healthcare Provider Details

I. General information

NPI: 1134130081
Provider Name (Legal Business Name): JAY PROSNITZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDWAY RD SUITE 101
MILFORD MA
01757-2923
US

IV. Provider business mailing address

9 INDUSTRIAL RD SUITE 5
MILFORD MA
01757-3588
US

V. Phone/Fax

Practice location:
  • Phone: 508-482-5425
  • Fax: 508-482-5430
Mailing address:
  • Phone: 508-473-1480
  • Fax: 508-473-1210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number49077
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: