Provider Demographics
NPI:1164754651
Name:EASTON, JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:EASTON
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 1:151 E 31ST ST
Mailing Address - Street 2:APT 11B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-9500
Mailing Address - Country:US
Mailing Address - Phone:212-532-8823
Mailing Address - Fax:
Practice Address - Street 1:151 E 31ST ST
Practice Address - Street 2:APT 11B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9500
Practice Address - Country:US
Practice Address - Phone:212-532-8823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA085515002084P0800X
NY1555172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry