Provider Demographics
NPI:1033108451
Name:JAKUS, JONATHAN (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:JAKUS
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 1:258 HIGH AVE
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-2407
Mailing Address - Country:US
Mailing Address - Phone:845-353-1441
Mailing Address - Fax:845-353-1987
Practice Address - Street 1:258 HIGH AVE
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-2407
Practice Address - Country:US
Practice Address - Phone:845-353-1441
Practice Address - Fax:845-353-1987
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127804207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0542164OtherAETNA HMO #
NY1000017625OtherAFFINITY #
NY127804OtherCONNECTICARE #
NYRP102OtherOXFORD #
NY103945OtherWELLCARE #
NY696487OtherMVP #
NY0008550OtherGHI PPO #
NY00000003945OtherGHI HMO #
NY00278120Medicaid
NY0D4695OtherHEALTHNET #
NY127804OtherHIP #
NY337001OtherEMPIRE BCBS #
NYKN6788OtherATLANTIS HEALTH PLAN #
NY4061574OtherAETNA PPO #
NY696487OtherTACONIC IPA #
NYKN6788OtherATLANTIS HEALTH PLAN #
NY00278120Medicaid