Basic Information
| Provider Information | |||||||||
| NPI: | 1780070789 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAINBERG | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | MD, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 255 W 85TH ST APT 14AB | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100243260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178352019 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7568 187TH ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | FRESH MEADOWS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113661726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183033720 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2015 | ||||||||
| LastUpdateDate: | 08/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208800000X | 311006 | NY | Y | Allopathic & Osteopathic Physicians | Urology |
No ID Information.