Provider Demographics
NPI:1093783367
Name:TRAGER, JONATHAN DAVID KURT (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DAVID KURT
Last Name:TRAGER
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 1:32 BERKSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2131
Mailing Address - Country:US
Mailing Address - Phone:516-466-6649
Mailing Address - Fax:
Practice Address - Street 1:212 MIDDLE NECK RD
Practice Address - Street 2:SUITE #5
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1126
Practice Address - Country:US
Practice Address - Phone:516-482-5400
Practice Address - Fax:516-482-5401
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200519207N00000X, 207NP0225X, 208000000X
NY200519-12080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
540991Medicare PIN