Provider Demographics
NPI:1053697896
Name:JAY M KORNGOLD MD PC
Entity type:Organization
Organization Name:JAY M KORNGOLD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMINTERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-634-4554
Mailing Address - Street 1:125 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956
Mailing Address - Country:US
Mailing Address - Phone:845-634-4554
Mailing Address - Fax:845-639-1959
Practice Address - Street 1:125 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956
Practice Address - Country:US
Practice Address - Phone:845-634-4554
Practice Address - Fax:845-639-1959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222599-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty