Basic Information
| Provider Information | |||||||||
| NPI: | 1336191204 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NATHAN | ||||||||
| FirstName: | JAY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 825 NORTHERN BLVD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110215323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167737500 | ||||||||
| FaxNumber: | 5167737595 | ||||||||
| Practice Location | |||||||||
| Address1: | 825 NORTHERN BLVD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110215323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167737500 | ||||||||
| FaxNumber: | 5167737595 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 01/20/2010 | ||||||||
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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 | 174400000X | 162000 | NY | Y | Other Service Providers | Specialist |
No ID Information.