Provider Demographics
NPI:1760029755
Name:MROZ, JONATHAN JOSEPH
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:JOSEPH
Last Name:MROZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2826 WESTCHESTER AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-4514
Mailing Address - Country:US
Mailing Address - Phone:718-515-2400
Mailing Address - Fax:
Practice Address - Street 1:2826 WESTCHESTER AVE STE 201
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4514
Practice Address - Country:US
Practice Address - Phone:718-515-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029893225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist