Provider Demographics
NPI:1215159488
Name:DAVE, JAY (DO)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:DAVE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1095 S BRADFORD ST # H088
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4141
Mailing Address - Country:US
Mailing Address - Phone:302-678-8100
Mailing Address - Fax:
Practice Address - Street 1:111 NEUROLOGY WAY
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-5368
Practice Address - Country:US
Practice Address - Phone:302-422-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT0111402084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1215159488Medicare PIN