Provider Demographics
NPI:1659515716
Name:JEZEQUEL, JONATHAN RYAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:RYAN
Last Name:JEZEQUEL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 E 48TH ST
Mailing Address - Street 2:SUITE 802
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-1014
Mailing Address - Country:US
Mailing Address - Phone:212-245-5500
Mailing Address - Fax:212-245-5540
Practice Address - Street 1:18 E 48TH ST
Practice Address - Street 2:SUITE 802
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1014
Practice Address - Country:US
Practice Address - Phone:212-245-5500
Practice Address - Fax:212-245-5540
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031316225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist