Healthcare Provider Details

I. General information

NPI: 1922196617
Provider Name (Legal Business Name): DR. JONATHAN BESCHLOSS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 NEW HYDE PARK RD
GARDEN CITY NY
11530-3909
US

IV. Provider business mailing address

143 HARRISON ST
GARDEN CITY NY
11530-2432
US

V. Phone/Fax

Practice location:
  • Phone: 516-488-1313
  • Fax:
Mailing address:
  • Phone: 718-664-8702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number0101240332
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number278210
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: