Provider Demographics
NPI:1386756906
Name:NFONOYIM, JAY M (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:M
Last Name:NFONOYIM
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 1:15 MAGUIRE CT # B1
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-2819
Mailing Address - Country:US
Mailing Address - Phone:718-370-9778
Mailing Address - Fax:718-370-9783
Practice Address - Street 1:355 BARD AVE
Practice Address - Street 2:MEDICINE/ CRITICAL CARE
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-1664
Practice Address - Country:US
Practice Address - Phone:718-818-4452
Practice Address - Fax:718-818-3225
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182840207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01355146Medicaid
NY01355146Medicaid
F307422Medicare UPIN