Healthcare Provider Details

I. General information

NPI: 1730160284
Provider Name (Legal Business Name): JAY DECESARE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT 44/55
PLEASANT VALLEY NY
12569
US

IV. Provider business mailing address

572 ULSTER AVE
KINGSTON NY
12401-1924
US

V. Phone/Fax

Practice location:
  • Phone: 845-635-5002
  • Fax: 845-635-5295
Mailing address:
  • Phone: 845-339-6000
  • Fax: 845-339-6065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX008697
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: