Provider Demographics
NPI:1700880069
Name:BRIGGS, JONATHAN HAVENS (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:HAVENS
Last Name:BRIGGS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 845592
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5592
Mailing Address - Country:US
Mailing Address - Phone:855-709-4531
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:1945 ROUTE 33
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4859
Practice Address - Country:US
Practice Address - Phone:732-776-4404
Practice Address - Fax:732-776-4672
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA072600002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00010444OtherRAILROAD MEDICARE
NJ0009067Medicaid
NJP00010444OtherRAILROAD MEDICARE
NJH15436Medicare UPIN