Provider Demographics
NPI:1972619823
Name:ASHKIN, JEFFREY ROY (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ROY
Last Name:ASHKIN
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 1:375 E MAIN ST
Mailing Address - Street 2:STE 21
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706
Mailing Address - Country:US
Mailing Address - Phone:631-968-8288
Mailing Address - Fax:631-968-8268
Practice Address - Street 1:375 E MAIN ST
Practice Address - Street 2:STE 21
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-968-8288
Practice Address - Fax:631-968-8268
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1268611207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00236599Medicaid
0298001Medicare ID - Type Unspecified
NY00236599Medicaid