Basic Information
| Provider Information | |||||||||
| NPI: | 1033178140 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOSEY | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | P. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1417 8TH AVE | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180182256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845265210 | ||||||||
| FaxNumber: | 4845265237 | ||||||||
| Practice Location | |||||||||
| Address1: | 1417 8TH AVE | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180182256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845265210 | ||||||||
| FaxNumber: | 4845265237 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2006 | ||||||||
| LastUpdateDate: | 01/06/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | MD045890L | PA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0600X | MD045890L | PA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Clinical Neurophysiology |
ID Information
| ID | Type | State | Issuer | Description | 001289764 | 05 | PA | MEDICAID | 0012897640002 | 05 | PA | MEDICAID |