Healthcare Provider Details

I. General information

NPI: 1457273799
Provider Name (Legal Business Name): JONATHAN DANIEL FLORES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E MAIN ST
MOUNT KISCO NY
10549
US

IV. Provider business mailing address

276 TEMPLE HILL RD UNIT 202
NEW WINDSOR NY
12553-6845
US

V. Phone/Fax

Practice location:
  • Phone: 914-666-1200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number86006201
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: