Provider Demographics
NPI:1497738322
Name:OKUN, JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:OKUN
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:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:HARRIS
Mailing Address - State:NY
Mailing Address - Zip Code:12742-0421
Mailing Address - Country:US
Mailing Address - Phone:845-794-9864
Mailing Address - Fax:845-794-9868
Practice Address - Street 1:PO BOX 421
Practice Address - Street 2:
Practice Address - City:HARRIS
Practice Address - State:NY
Practice Address - Zip Code:12742-0421
Practice Address - Country:US
Practice Address - Phone:845-794-9864
Practice Address - Fax:845-794-9868
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2023-09-06
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-03-10
Provider Licenses
StateLicense IDTaxonomies
NY195024207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5207D1Medicare ID - Type Unspecified
I01525Medicare UPIN