MEDICARE: JONATHAN JOSEPHS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	DN25611	FL

General Provider Information

NPI Number	:	1457986648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN JOSEPHS

Provider Business Mailing Address
First Line	:	44 COCOANUT ROW STE 206
Second Line	:
City	:	PALM BEACH
State	:	FL
Zip	:	33480-4069
Country	:	US
Telephone Number	:	617-658-3382
Fax Number	:

Provider Business Practice Location Address
First Line	:	44 COCOANUT ROW STE 206
Second Line	:
City	:	PALM BEACH
State	:	FL
Zip	:	33480-4069
Country	:	US
Telephone Number	:	561-832-4675
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2020
Last Update Date	:	02/28/2023

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Directions to “ JONATHAN JOSEPHS ” Practice Location

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