Provider Demographics
NPI:1043209158
Name:MARGOLIN, JONATHAN D III
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:D
Last Name:MARGOLIN
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 STEPHENSON AVE
Mailing Address - Street 2:
Mailing Address - City:FT. MONMOUTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 HOLLAND LN
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08512-3003
Practice Address - Country:US
Practice Address - Phone:732-532-3859
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02556600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI02556600OtherLICENSE