Provider Demographics
NPI:1134552110
Name:ELIAS, JONATHAN S (DPT)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:S
Last Name:ELIAS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 WOODROW ROAD718966
Mailing Address - Street 2:SUITE 321
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309
Mailing Address - Country:US
Mailing Address - Phone:718-844-5350
Mailing Address - Fax:718-966-0005
Practice Address - Street 1:31 NEW DORP LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2351
Practice Address - Country:US
Practice Address - Phone:718-370-3500
Practice Address - Fax:718-979-5236
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036531225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist