Provider Demographics
NPI:1346578119
Name:AUGUST, JONATHAN (PT, ATC, HHC)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:AUGUST
Suffix:
Gender:M
Credentials:PT, ATC, HHC
Other - Prefix:MR
Other - First Name:JONATHAN
Other - Middle Name:
Other - Last Name:AUGUST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, ATC, HHC
Mailing Address - Street 1:100 RIVERSIDE BLVD
Mailing Address - Street 2:16H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10069-0401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 RIVERSIDE BLVD
Practice Address - Street 2:16H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10069-0401
Practice Address - Country:US
Practice Address - Phone:212-724-7871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-06
Last Update Date:2009-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19506225100000X
MA13179225100000X
MA0895023972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer