Doctor Name: | DR. JONATHAN WAHL |
NPI Number: | 1821155755 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 232419 |
Business Practice Address: | 471 N Broadway Suite 278 Jericho, NY - 117532106 |
Business Phone Number: | 5166956340 |
Business Fax Number: | 7183680400 |
Mailing Address: | 471 N Broadway, Suite 278 JERICHO |
State: | NY |
Postal Code: | 117532106 |
Phone Number: | 5166956340 |
Fax Number: | 7183680400 |
NPI Enumeration Date: | 01/02/2007 |
NPI Last Update Date: | 11/03/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 232419 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |