Healthcare Provider Details

I. General information

NPI: 1316558596
Provider Name (Legal Business Name): JONATHAN ADAR SHECTMAN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 W 58TH ST
NEW YORK NY
10019-1005
US

IV. Provider business mailing address

PO BOX 626
GREAT RIVER NY
11739-0626
US

V. Phone/Fax

Practice location:
  • Phone: 212-606-1136
  • Fax: 212-606-1109
Mailing address:
  • Phone: 212-606-1166
  • Fax: 212-606-1109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number356658
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number979934
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: