Healthcare Provider Details

I. General information

NPI: 1023146925
Provider Name (Legal Business Name): JONATHAN LAYTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 13TH ST SUITE 201
BROOKLYN NY
11215-5004
US

IV. Provider business mailing address

348 13TH. ST SUITE 201
BROOKLYN NY
11215-5004
US

V. Phone/Fax

Practice location:
  • Phone: 718-636-2900
  • Fax: 718-636-2902
Mailing address:
  • Phone: 718-636-2900
  • Fax: 718-636-2902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number142547
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: