Provider Demographics
NPI:1154428613
Name:GLADSTEIN, JAY E (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:E
Last Name:GLADSTEIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5901 W OLYMPIC BLVD
Mailing Address - Street 2:206
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4667
Mailing Address - Country:US
Mailing Address - Phone:323-215-1725
Mailing Address - Fax:323-271-4154
Practice Address - Street 1:5901 W OLYMPIC BLVD
Practice Address - Street 2:206
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4667
Practice Address - Country:US
Practice Address - Phone:323-215-1725
Practice Address - Fax:323-271-4154
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2016-11-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA83112207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB682ZOtherMEDICARE PTAN
CA1013144187Medicaid
CAP00745200OtherRAILROAD MEDICARE