Provider Demographics
NPI:1710229240
Name:SPORN, JONATHAN (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:SPORN
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 1:230 RIVERSIDE DR
Mailing Address - Street 2:19D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6105
Mailing Address - Country:US
Mailing Address - Phone:347-967-6831
Mailing Address - Fax:
Practice Address - Street 1:230 RIVERSIDE DR
Practice Address - Street 2:19D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6105
Practice Address - Country:US
Practice Address - Phone:347-967-6831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247387-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry