Provider Demographics
NPI:1023017688
Name:MARGOLIN, JONATHAN HOWARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:HOWARD
Last Name:MARGOLIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 QUEEN ANNE RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3234
Mailing Address - Country:US
Mailing Address - Phone:201-836-2126
Mailing Address - Fax:201-353-2497
Practice Address - Street 1:470 QUEEN ANNE RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3234
Practice Address - Country:US
Practice Address - Phone:201-836-2126
Practice Address - Fax:201-353-2497
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005602213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02339068Medicaid
NYU90979Medicare UPIN
NYPH1501Medicare ID - Type Unspecified