Healthcare Provider Details

I. General information

NPI: 1497738322
Provider Name (Legal Business Name): JONATHAN OKUN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date: 07/17/2007
Reactivation Date: 03/10/2008

III. Provider practice location address

PO BOX 421
HARRIS NY
12742-0421
US

IV. Provider business mailing address

PO BOX 421
HARRIS NY
12742-0421
US

V. Phone/Fax

Practice location:
  • Phone: 845-794-9864
  • Fax: 845-794-9868
Mailing address:
  • Phone: 845-794-9864
  • Fax: 845-794-9868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number195024
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA07836500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: