Provider Demographics
NPI:1083860951
Name:BANK, JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:BANK
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 1:833 NORTHERN BLVD
Mailing Address - Street 2:STE 160
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5315
Mailing Address - Country:US
Mailing Address - Phone:516-498-8400
Mailing Address - Fax:516-498-8404
Practice Address - Street 1:833 NORTHERN BLVD
Practice Address - Street 2:STE 160
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5315
Practice Address - Country:US
Practice Address - Phone:516-498-8400
Practice Address - Fax:516-498-8404
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY280361-1208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery