Provider Demographics
NPI:1235303124
Name:HOUSE, JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:HOUSE
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 1:1050 5TH AVE
Mailing Address - Street 2:OFFICE #4
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0110
Mailing Address - Country:US
Mailing Address - Phone:212-722-5345
Mailing Address - Fax:646-672-0741
Practice Address - Street 1:1050 5TH AVE
Practice Address - Street 2:OFFICE #4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0110
Practice Address - Country:US
Practice Address - Phone:212-722-5345
Practice Address - Fax:646-672-0741
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1382752084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry