MEDICARE: DR. JAY DANIEL PARKINSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	245865	NY
2	2083P0901X	Public Health & General Preventive Medicine Physician	245865	NY
3	208D00000X	General Practice Physician	245865	NY

General Provider Information

NPI Number	:	1235323171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY DANIEL PARKINSON M.D.

Provider Business Mailing Address
First Line	:	459 KEAP ST
Second Line	:	APT #3
City	:	BROOKLYN
State	:	NY
Zip	:	11211-3433
Country	:	US
Telephone Number	:	917-753-0751
Fax Number	:

Provider Business Practice Location Address
First Line	:	459 KEAP ST
Second Line	:	APT #3
City	:	BROOKLYN
State	:	NY
Zip	:	11211-3433
Country	:	US
Telephone Number	:	917-753-0751
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2007
Last Update Date	:	09/04/2007

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