Healthcare Provider Details

I. General information

NPI: 1851928261
Provider Name (Legal Business Name): JONATHAN ELIEZER SHALOT DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 PARK AVE STE 103
NEW YORK NY
10075-0325
US

IV. Provider business mailing address

885 PARK AVE STE 103
NEW YORK NY
10075-0325
US

V. Phone/Fax

Practice location:
  • Phone: 212-535-0229
  • Fax: 212-452-1292
Mailing address:
  • Phone: 212-535-0229
  • Fax: 212-452-1292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number007279
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: