1396704755 NPI number — JONATHAN S. DOSIK M.D.

Table of content: (NPI 1356956775)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396704755 NPI number — JONATHAN S. DOSIK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOSIK
Provider First Name:
JONATHAN
Provider Middle Name:
S.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396704755
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
348 S MAPLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN ROCK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07452-1542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-652-6060
Provider Business Mailing Address Fax Number:
201-652-1882

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
348 S MAPLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLEN ROCK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07452-1542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-652-6060
Provider Business Practice Location Address Fax Number:
201-652-1882
Provider Enumeration Date:
03/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  MA70663 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00223215 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0090590 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".