Healthcare Provider Details

I. General information

NPI: 1336787597
Provider Name (Legal Business Name): JONATHAN KORASON DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2019
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 OLD COUNTRY RD
PLAINVIEW NY
11803-4938
US

IV. Provider business mailing address

33 LANE AVE
PLAINVIEW NY
11803-5206
US

V. Phone/Fax

Practice location:
  • Phone: 516-870-1429
  • Fax: 516-870-1477
Mailing address:
  • Phone: 516-580-9740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number042124
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: