Provider Demographics
NPI:1477062800
Name:RHODES, JONATHAN (NP-P)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:RHODES
Suffix:
Gender:M
Credentials:NP-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 HENRY ST APT 23J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1755
Mailing Address - Country:US
Mailing Address - Phone:443-974-8386
Mailing Address - Fax:
Practice Address - Street 1:1088 HIGHWAY 34
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NJ
Practice Address - Zip Code:07747-1948
Practice Address - Country:US
Practice Address - Phone:732-290-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402227363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health