Provider Demographics
NPI:1124162714
Name:JAY C COWAN MD LLC
Entity type:Organization
Organization Name:JAY C COWAN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:C
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-281-5252
Mailing Address - Street 1:470 MALCOLM X BLVD
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-3003
Mailing Address - Country:US
Mailing Address - Phone:212-281-5252
Mailing Address - Fax:212-690-3662
Practice Address - Street 1:470 MALCOLM X BLVD
Practice Address - Street 2:SUITE 1E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-3003
Practice Address - Country:US
Practice Address - Phone:212-281-5252
Practice Address - Fax:212-690-3662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201885207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP403507OtherOXFORD
NY175024OtherELDERPLAN
NY01640266Medicaid
NY2595501OtherGHI
NY201885OtherHIP
NY49J85OtherEMPIRE BLUE CROSS
NY1000000998OtherAFFINITY HEALTH PLAN
NYE99698Medicare UPIN
NY2595501OtherGHI