Provider Demographics
NPI:1184838872
Name:JONATHAN MOHRER MD PC
Entity Type:Organization
Organization Name:JONATHAN MOHRER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MOHRER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-575-9787
Mailing Address - Street 1:11406 QUEENS BLVD
Mailing Address - Street 2:SUITE A8
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7001
Mailing Address - Country:US
Mailing Address - Phone:718-575-9787
Mailing Address - Fax:
Practice Address - Street 1:11406 QUEENS BLVD
Practice Address - Street 2:SUITE A8
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7001
Practice Address - Country:US
Practice Address - Phone:718-575-9787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA151328-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY08210Medicare PIN