1568972859 NPI number — JONATHAN CATRONA PA-C

Table of content: JONATHAN CATRONA PA-C (NPI 1568972859)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568972859 NPI number — JONATHAN CATRONA PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CATRONA
Provider First Name:
JONATHAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1568972859
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 WOODCLIFF RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ISLIP TERRACE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11752-1914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-942-8484
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6277 JERICHO TPKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COMMACK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11725-2837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-462-6644
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2017

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: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1139940 . This is a "NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS" identifier . This identifiers is of the category "OTHER".




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