Provider Demographics
NPI:1063551109
Name:MOSTOWY, JAY H (DDS)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:H
Last Name:MOSTOWY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3963 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:NY
Mailing Address - Zip Code:14226
Mailing Address - Country:US
Mailing Address - Phone:716-839-0445
Mailing Address - Fax:716-839-2510
Practice Address - Street 1:3963 HARLEM RD
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-839-0445
Practice Address - Fax:716-839-2510
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042731122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01451692Medicaid