Provider Demographics
NPI:1780758425
Name:SHERWYN, JONATHAN HILTON (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:HILTON
Last Name:SHERWYN
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 1:50 E 79TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0276
Mailing Address - Country:US
Mailing Address - Phone:212-517-2700
Mailing Address - Fax:212-517-2828
Practice Address - Street 1:50 E 79TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0232
Practice Address - Country:US
Practice Address - Phone:212-517-2700
Practice Address - Fax:212-517-2828
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169680174400000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE48923Medicare UPIN
NY56F581Medicare ID - Type UnspecifiedPROVIDER