Healthcare Provider Details

I. General information

NPI: 1982820585
Provider Name (Legal Business Name): JONATHAN ERIC OKON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 E 58TH ST STE 807
NEW YORK NY
10022-1122
US

IV. Provider business mailing address

47 BRACKETT RD
NEWTON MA
02458-2611
US

V. Phone/Fax

Practice location:
  • Phone: 212-380-1165
  • Fax:
Mailing address:
  • Phone: 617-964-7375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number049-245
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN 20180-1
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: