1497710388 NPI number — JAY S COWEN MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497710388 NPI number — JAY S COWEN MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

COWEN

Provider First Name:

JAY

Provider Middle Name:

S

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1497710388

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

11/09/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

DEPT 4392

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

CAROL STREAM

Provider Business Mailing Address State Name:

IL

Provider Business Mailing Address Postal Code:

60122-0001

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

866-540-5303

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

750 W 800 N

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

OREM

Provider Business Practice Location Address State Name:

UT

Provider Business Practice Location Address Postal Code:

84057-3660

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

801-783-5011

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

04/20/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RC0200X , with the licence number:  MD044182L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RP1001X , with the licence number: 036100737 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208M00000X , with the licence number: 11467514-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RC0200X , with the licence number: 11467514-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 036100737 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
• Identifier: 0361007372 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
• Identifier: 0695176000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 30019159 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 752958 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0014579300005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 145793001 . This is a "AMERICHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 34928MD044182L . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".