Provider Demographics
NPI:1104023910
Name:JONATHAN BEACH DO PLLC
Entity Type:Organization
Organization Name:JONATHAN BEACH DO PLLC
Other - Org Name:URGICARE OF THE NORTHEAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BEACH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:518-563-5900
Mailing Address - Street 1:505 DEVILS DEN RD
Mailing Address - Street 2:
Mailing Address - City:ALTONA
Mailing Address - State:NY
Mailing Address - Zip Code:12910-2018
Mailing Address - Country:US
Mailing Address - Phone:518-236-5611
Mailing Address - Fax:
Practice Address - Street 1:79 HAMMOND LN
Practice Address - Street 2:SUITE #2
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2008
Practice Address - Country:US
Practice Address - Phone:518-563-5900
Practice Address - Fax:519-563-5903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228601261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care