Healthcare Provider Details

I. General information

NPI: 1225768120
Provider Name (Legal Business Name): JONAH SIDNEY WINAKOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11050 MT BELVEDERE BLVD
FORT DRUM NY
13602-2603
US

IV. Provider business mailing address

11050 MT BELVEDERE BLVD
FORT DRUM NY
13602-2603
US

V. Phone/Fax

Practice location:
  • Phone: 315-772-0215
  • Fax:
Mailing address:
  • Phone: 860-754-7066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number36308
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: