Provider Demographics
NPI:1881692648
Name:FOGEL, JONATHAN TAD (MD)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:TAD
Last Name:FOGEL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1345 RXR PLZ FL 13
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11556-1301
Mailing Address - Country:US
Mailing Address - Phone:516-453-0435
Mailing Address - Fax:646-846-3283
Practice Address - Street 1:1470 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-7446
Practice Address - Country:US
Practice Address - Phone:718-571-9270
Practice Address - Fax:716-859-7388
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2018-10-23
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Provider Licenses
StateLicense IDTaxonomies
NY2483962085R0204X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIH23822Medicare UPIN