Provider Demographics
NPI:1154327435
Name:DORN, JONATHAN J (OD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:J
Last Name:DORN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 ROUTE 72 W
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2414
Mailing Address - Country:US
Mailing Address - Phone:609-597-8087
Mailing Address - Fax:609-597-7192
Practice Address - Street 1:1206 ROUTE 72 W
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2414
Practice Address - Country:US
Practice Address - Phone:609-597-8087
Practice Address - Fax:609-597-7192
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OM00013700152W00000X
NJ27OA00505500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0045402OtherAETNA
NJ0448874000OtherAMERIHEALTH
NJ1066306OtherHORIZON NJ HEALTHCARE
NJ311078OtherNVA
NJ3429901000OtherAMERIHEALTH
NJ0099937Medicaid
NJ13738OtherSPECTERA
NJ7497806Medicaid
NJ27OA00505500OtherNJ LICENSE
NJ191112OtherAMERIGROUP
NJ1K6864OtherHEALTHNET
NJ6021624OtherCIGNA
NJP00616550OtherRAILROAD TRAVELERS
NJ38180OtherDAVIS VISION
NJ191112OtherAMERIGROUP
NJU01156Medicare UPIN
NJ0099937Medicaid
NJAT113941Medicare PIN
NJ0045402OtherAETNA