Healthcare Provider Details

I. General information

NPI: 1356403364
Provider Name (Legal Business Name): JONATHAN S ILOWITE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 LAKEVILLE RD STE 105
NEW HYDE PARK NY
11042-1102
US

IV. Provider business mailing address

410 LAKEVILLE RD STE 105
NEW HYDE PARK NY
11042-1102
US

V. Phone/Fax

Practice location:
  • Phone: 516-465-5400
  • Fax: 164-655-3925
Mailing address:
  • Phone: 516-465-5400
  • Fax: 516-465-5392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number158477
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number158477
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: