Provider Demographics
NPI:1740691450
Name:ROY, JONATHAN RICHARD (DPM, MS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:RICHARD
Last Name:ROY
Suffix:
Gender:M
Credentials:DPM, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 W 32ND ST RM 1503
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3841
Mailing Address - Country:US
Mailing Address - Phone:646-321-4494
Mailing Address - Fax:929-223-4465
Practice Address - Street 1:39 W 32ND ST RM 1503
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3841
Practice Address - Country:US
Practice Address - Phone:646-321-4494
Practice Address - Fax:929-223-4465
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00337600213ES0103X
NYN006759-1213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery