Provider Demographics
NPI:1629551908
Name:JONATHAN ROY DPM PC
Entity Type:Organization
Organization Name:JONATHAN ROY DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-532-6679
Mailing Address - Street 1:140 N RTE 17 STE 103
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2809
Mailing Address - Country:US
Mailing Address - Phone:718-532-6679
Mailing Address - Fax:
Practice Address - Street 1:140 N RTE 17 STE 103
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2809
Practice Address - Country:US
Practice Address - Phone:718-532-6679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty