Healthcare Provider Details

I. General information

NPI: 1174641336
Provider Name (Legal Business Name): JAY MARTIN IZES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

967 N BROADWAY ROOM 101
YONKERS NY
10701-1301
US

IV. Provider business mailing address

967 N BROADWAY ROOM 101
YONKERS NY
10701-1301
US

V. Phone/Fax

Practice location:
  • Phone: 914-964-4965
  • Fax: 914-964-4556
Mailing address:
  • Phone: 914-964-4965
  • Fax: 914-964-4556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number114229
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number114229
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: