Healthcare Provider Details

I. General information

NPI: 1043262819
Provider Name (Legal Business Name): JONATHAN C WINICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 E MAIN ST SUITE 1
BAY SHORE NY
11706-8415
US

IV. Provider business mailing address

370 E MAIN ST SUITE 1
BAY SHORE NY
11706-8415
US

V. Phone/Fax

Practice location:
  • Phone: 631-666-4767
  • Fax: 631-665-2153
Mailing address:
  • Phone: 631-666-4767
  • Fax: 631-665-2153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number195770
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number195770
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: