Provider Demographics
NPI:1699215269
Name:NOURY, JONATHAN ISSAC (MSPT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ISSAC
Last Name:NOURY
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 E 44TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-4008
Mailing Address - Country:US
Mailing Address - Phone:212-490-3800
Mailing Address - Fax:212-490-6657
Practice Address - Street 1:144 E 44TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4008
Practice Address - Country:US
Practice Address - Phone:212-490-3800
Practice Address - Fax:212-490-6657
Is Sole Proprietor?:No
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040698-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist