Provider Demographics
NPI:1629337928
Name:GIFTOS, JONATHAN MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MATTHEW
Last Name:GIFTOS
Suffix:
Gender:M
Credentials:MD
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Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:415 9TH ST APT 33
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4151
Mailing Address - Country:US
Mailing Address - Phone:603-682-4543
Mailing Address - Fax:
Practice Address - Street 1:8 E 3RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-8908
Practice Address - Country:US
Practice Address - Phone:212-533-8400
Practice Address - Fax:212-529-4781
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY276899207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine