Healthcare Provider Details

I. General information

NPI: 1497710388
Provider Name (Legal Business Name): JAY S COWEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 W 800 N
OREM UT
84057-3660
US

IV. Provider business mailing address

DEPT 4392
CAROL STREAM IL
60122-0001
US

V. Phone/Fax

Practice location:
  • Phone: 801-783-5011
  • Fax:
Mailing address:
  • Phone: 866-540-5303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD044182L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036100737
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number11467514-1205
License Number StateUT
# 4
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number11467514-1205
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier036100737
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerBLUE CROSS BLUE SHIELD
# 2
Identifier0361007372
Identifier TypeMEDICAID
Identifier StateIL
Identifier Issuer
# 3
Identifier0695176000
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerINDEPENDENCE BLUE CROSS
# 4
Identifier30019159
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerKEYSTONE MERCY
# 5
Identifier752958
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BLUE SHIELD
# 6
Identifier0014579300005
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 7
Identifier145793001
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAMERICHOICE
# 8
Identifier34928MD044182L
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHEALTH PARTNERS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: