Healthcare Provider Details

I. General information

NPI: 1053309195
Provider Name (Legal Business Name): JONATHAN L FELLUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 E 32ND ST FL 12
NEW YORK NY
10016-6055
US

IV. Provider business mailing address

145 E 32ND ST FL 12
NEW YORK NY
10016-6055
US

V. Phone/Fax

Practice location:
  • Phone: 917-694-4426
  • Fax: 212-931-4877
Mailing address:
  • Phone: 973-787-7402
  • Fax: 212-931-4877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number313031
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: