Provider Demographics
NPI:1689833055
Name:SOVEROW, JONATHAN E (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:E
Last Name:SOVEROW
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 1:161 FT WASHINGTN AVE
Mailing Address - Street 2:HERBERT-IRVING PAVILION 6TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3729
Mailing Address - Country:US
Mailing Address - Phone:212-305-7060
Mailing Address - Fax:
Practice Address - Street 1:161 FT WASHINGTN AVE
Practice Address - Street 2:HERBERT IRVING PAVILION 6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3729
Practice Address - Country:US
Practice Address - Phone:212-305-7060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAL-236078207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine