Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 25MD00167000 | NJ |
N | 222Z00000X | Podiatrist | 25MD00167000 | NJ |
Y | 213E00000X | Podiatrist | NO002971-1 | NY |
Y | 222Z00000X | Podiatrist | NO002971-1 | NY |
NPI | 1053310920 |
---|---|
Provider Name | Jay M Purvin |
First Address | East Meadow, NY 11554-2714 |
Second Address | East Meadow, NY 11554-2714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2005 |
Last Update Date | 15/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00406217 | (05) | NY |
0758507 | (05) | NJ |
T50924 | (02) | NY |