Provider Demographics
NPI:1689887705
Name:JASSEY, JONATHAN BRETT (DO)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:BRETT
Last Name:JASSEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2 HARVEST CT
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5602
Mailing Address - Country:US
Mailing Address - Phone:631-486-4561
Mailing Address - Fax:
Practice Address - Street 1:1520 OLD NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1126
Practice Address - Country:US
Practice Address - Phone:516-514-7337
Practice Address - Fax:802-491-8229
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY243849-12080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine