Healthcare Provider Details

I. General information

NPI: 1225731052
Provider Name (Legal Business Name): JONATHAN JEONG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E 77TH ST
NEW YORK NY
10075-1851
US

IV. Provider business mailing address

333 LIBERTY RD
TEANECK NJ
07666-6310
US

V. Phone/Fax

Practice location:
  • Phone: 212-434-4763
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number25MB13105800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MB13105800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: