Provider Demographics
NPI:1558385203
Name:DEMURO, JONAS (MD)
Entity Type:Individual
Prefix:
First Name:JONAS
Middle Name:
Last Name:DEMURO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:120 MINEOLA BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4064
Mailing Address - Country:US
Mailing Address - Phone:516-663-3300
Mailing Address - Fax:516-663-2136
Practice Address - Street 1:120 MINEOLA BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4064
Practice Address - Country:US
Practice Address - Phone:516-663-3300
Practice Address - Fax:516-663-2136
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY220572208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1558385203Medicare PIN