Provider Demographics
NPI:1578941753
Name:HORNIK, JONATAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATAN
Middle Name:
Last Name:HORNIK
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 3988
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-3988
Mailing Address - Country:US
Mailing Address - Phone:618-457-5200
Mailing Address - Fax:
Practice Address - Street 1:305 W JACKSON ST STE 103
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1474
Practice Address - Country:US
Practice Address - Phone:618-351-4972
Practice Address - Fax:618-351-6522
Is Sole Proprietor?:No
Enumeration Date:2015-05-08
Last Update Date:2021-07-20
Deactivation Date:2015-12-16
Deactivation Code:
Reactivation Date:2016-01-06
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL0361498172084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program