Provider Demographics
NPI:1265538458
Name:LOWN, JONATHAN SAUL (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:SAUL
Last Name:LOWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2171 JERICHO TPKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2937
Mailing Address - Country:US
Mailing Address - Phone:631-343-7242
Mailing Address - Fax:631-343-7245
Practice Address - Street 1:2171 JERICHO TPKE
Practice Address - Street 2:SUITE 100
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2937
Practice Address - Country:US
Practice Address - Phone:631-343-7242
Practice Address - Fax:631-343-7245
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2020-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY204673207RS0012X, 332B00000X
NY204673-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01876017Medicaid
NY01876017Medicaid
NY795691Medicare ID - Type Unspecified