Provider Demographics
NPI:1194473900
Name:JONATHAN ERBER MD PC
Entity Type:Organization
Organization Name:JONATHAN ERBER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGIV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-605-7765
Mailing Address - Street 1:591 OCEAN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-5913
Mailing Address - Country:US
Mailing Address - Phone:917-605-7765
Mailing Address - Fax:718-972-0064
Practice Address - Street 1:591 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-5913
Practice Address - Country:US
Practice Address - Phone:917-605-7765
Practice Address - Fax:718-972-0064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02992574Medicaid