Provider Demographics
NPI:1821246190
Name:SNYDER, JON BRANDON (ATC)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:BRANDON
Last Name:SNYDER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 E 120TH ST
Mailing Address - Street 2:APT. #5B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-3667
Mailing Address - Country:US
Mailing Address - Phone:561-512-7303
Mailing Address - Fax:
Practice Address - Street 1:1500 ASTOR AVE
Practice Address - Street 2:SUITE 1E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5900
Practice Address - Country:US
Practice Address - Phone:718-652-4295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001538-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer