Healthcare Provider Details

I. General information

NPI: 1841293388
Provider Name (Legal Business Name): JONATHAN ABRAHAM KIRELL DPM; DABFS; CTHA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 HARDWICK DR
SOUTH HUNTINGTON NY
11746-4550
US

IV. Provider business mailing address

22 HARDWICK DR
SOUTH HUNTINGTON NY
11746-4550
US

V. Phone/Fax

Practice location:
  • Phone: 631-673-1019
  • Fax:
Mailing address:
  • Phone: 631-673-1019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN003097
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: