Provider Demographics
NPI:1467547216
Name:SNYDER, JON ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:ROBERT
Last Name:SNYDER
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 1:530 1ST AVE
Mailing Address - Street 2:SUITE 10N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6402
Mailing Address - Country:US
Mailing Address - Phone:212-263-6356
Mailing Address - Fax:212-263-1016
Practice Address - Street 1:530 1ST AVE
Practice Address - Street 2:SUITE 10N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-6356
Practice Address - Fax:212-263-1016
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117139207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY112710393OtherTAX ID
NY117139OtherLICENCE NUMBER
NY117139OtherLICENCE NUMBER
NY112710393OtherTAX ID
NY343271Medicare ID - Type Unspecified