Provider Demographics
NPI:1306800073
Name:CUNNINGHAM, JAY ERIC (DPM)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:ERIC
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 MEMORIAL BLVD
Mailing Address - Street 2:D
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-1418
Mailing Address - Country:US
Mailing Address - Phone:724-626-7620
Mailing Address - Fax:724-626-1338
Practice Address - Street 1:2616 MEMORIAL BLVD
Practice Address - Street 2:D
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-1418
Practice Address - Country:US
Practice Address - Phone:724-626-7620
Practice Address - Fax:724-626-1338
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004557R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017463070004Medicaid
PA025180Medicare ID - Type UnspecifiedMEDICARE
PA0017463070004Medicaid