Basic Information
| Provider Information | |||||||||
| NPI: | 1023129442 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JAY M MARKOWITZ MD & ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 SALUDA RIDGE CT | ||||||||
| Address2: | |||||||||
| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291693455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037943320 | ||||||||
| FaxNumber: | 8037943157 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 SALUDA RIDGE CT | ||||||||
| Address2: | |||||||||
| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291693455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037943320 | ||||||||
| FaxNumber: | 8037943157 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 11/19/2009 | ||||||||
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| AuthorizedOfficialLastName: | RILEY | ||||||||
| AuthorizedOfficialFirstName: | JILL | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8037943320 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | GP1293 | 05 | SC | MEDICAID |