Basic Information
| Provider Information | |||||||||
| NPI: | 1336144104 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JONATHAN DAVID, MD, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 136 SAGAMORE RD | ||||||||
| Address2: | |||||||||
| City: | TUCKAHOE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107074009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143376400 | ||||||||
| FaxNumber: | 9143378109 | ||||||||
| Practice Location | |||||||||
| Address1: | 136 SAGAMORE RD | ||||||||
| Address2: | |||||||||
| City: | TUCKAHOE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107074009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143376400 | ||||||||
| FaxNumber: | 9143378109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 07/28/2010 | ||||||||
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| AuthorizedOfficialLastName: | DAVID | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9143376400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 178695 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.