Healthcare Provider Details

I. General information

NPI: 1235323171
Provider Name (Legal Business Name): JAY DANIEL PARKINSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 KEAP ST APT #3
BROOKLYN NY
11211-3433
US

IV. Provider business mailing address

459 KEAP ST APT #3
BROOKLYN NY
11211-3433
US

V. Phone/Fax

Practice location:
  • Phone: 917-753-0751
  • Fax:
Mailing address:
  • Phone: 917-753-0751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number245865
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number245865
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number245865
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: