Provider Demographics
NPI:1467613216
Name:JONISCH, JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:JONISCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:600 NORTHERN BLVD
Mailing Address - Street 2:STE 216
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5200
Mailing Address - Country:US
Mailing Address - Phone:516-466-0390
Mailing Address - Fax:516-466-4956
Practice Address - Street 1:600 NORTHERN BLVD
Practice Address - Street 2:SUITE 216
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5206
Practice Address - Country:US
Practice Address - Phone:516-594-1010
Practice Address - Fax:516-594-6058
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2022-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY245936207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology