MEDICARE: JONATHAN DREW ALTUS MD

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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	164913	NY
2	207RP1001X	Pulmonary Disease Physician	164913	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871575647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN DREW ALTUS MD

Provider Business Mailing Address
First Line	:	920 ATLANTIC AVE
Second Line	:
City	:	BALDWIN HARBOR
State	:	NY
Zip	:	11510-4241
Country	:	US
Telephone Number	:	516-623-8700
Fax Number	:	516-623-3746

Provider Business Practice Location Address
First Line	:	920 ATLANTIC AVE
Second Line	:
City	:	BALDWIN HARBOR
State	:	NY
Zip	:	11510-4241
Country	:	US
Telephone Number	:	516-623-8700
Fax Number	:	516-623-3746

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

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	07/23/2015

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