Provider Demographics
NPI:1467416131
Name:WESSON, JONATHAN TODD (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:TODD
Last Name:WESSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:33 W GATE BLVD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1452
Mailing Address - Country:US
Mailing Address - Phone:516-570-0655
Mailing Address - Fax:
Practice Address - Street 1:8 MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2102
Practice Address - Country:US
Practice Address - Phone:516-676-4596
Practice Address - Fax:516-674-0502
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208199207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG97637Medicare UPIN
NY406A91Medicare PIN