Provider Demographics
NPI:1497053474
Name:JON R SNYDER M D P C
Entity Type:Organization
Organization Name:JON R SNYDER M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:P C
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:212-263-6356
Mailing Address - Street 1:530 1ST AVE
Mailing Address - Street 2:10N
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 2:10N
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117139207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY117139OtherLICENCE
AS6876568OtherDEA
NY117139OtherLICENCE
NYCO8870Medicare UPIN