Provider Demographics
NPI:1265761548
Name:KUDROWITZ, JONATHAN (PA-C)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:KUDROWITZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6385 SWEET MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-1934
Mailing Address - Country:US
Mailing Address - Phone:561-289-7661
Mailing Address - Fax:
Practice Address - Street 1:6931 W BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2902
Practice Address - Country:US
Practice Address - Phone:954-321-5191
Practice Address - Fax:954-321-5192
Is Sole Proprietor?:No
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105136363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant