Healthcare Provider Details

I. General information

NPI: 1992390355
Provider Name (Legal Business Name): JONATHAN SANON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2021
Last Update Date: 03/07/2021
Certification Date: 03/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 BONNIE CT
SPRING VALLEY NY
10977-2222
US

IV. Provider business mailing address

8 BONNIE CT
SPRING VALLEY NY
10977-2222
US

V. Phone/Fax

Practice location:
  • Phone: 845-287-1770
  • Fax:
Mailing address:
  • Phone: 845-287-1770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number682763680
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number682763680
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: