Provider Demographics
NPI:1104815679
Name:BOLNICK, JAY M (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:M
Last Name:BOLNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 ORCHARD PARK RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-4658
Mailing Address - Country:US
Mailing Address - Phone:716-675-5222
Mailing Address - Fax:
Practice Address - Street 1:3050 ORCHARD PARK RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-4658
Practice Address - Country:US
Practice Address - Phone:716-675-5222
Practice Address - Fax:716-675-9329
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237929207VE0102X
PAMD438097207VM0101X
NY237929-1207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03222671Medicaid
CTD28972Medicare UPIN
NY03222671Medicaid