Provider Demographics
NPI:1720277221
Name:UMSTADT, JONATHAN MATTHEW (RPH)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:MATTHEW
Last Name:UMSTADT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2465 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-2028
Mailing Address - Country:US
Mailing Address - Phone:516-579-6769
Mailing Address - Fax:
Practice Address - Street 1:2465 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2028
Practice Address - Country:US
Practice Address - Phone:516-579-6769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-20
Last Update Date:2007-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist