Provider Demographics
NPI:1851928261
Name:SHALOT, JONATHAN ELIEZER (DPM)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ELIEZER
Last Name:SHALOT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 HUDSON ST BSMT FL70
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5630
Mailing Address - Country:US
Mailing Address - Phone:201-659-5222
Mailing Address - Fax:
Practice Address - Street 1:70 HUDSON ST BSMT FL70
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5630
Practice Address - Country:US
Practice Address - Phone:201-659-5222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00373600213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty