Provider Demographics
NPI:1902975550
Name:FOOTE, JAY BRADLEY (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:BRADLEY
Last Name:FOOTE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3302 STEUBEN AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2806
Mailing Address - Country:US
Mailing Address - Phone:718-231-6964
Mailing Address - Fax:914-861-2550
Practice Address - Street 1:3302 STEUBEN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2806
Practice Address - Country:US
Practice Address - Phone:718-920-4263
Practice Address - Fax:718-920-6538
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2020-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1713212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE94846Medicare UPIN