Healthcare Provider Details

I. General information

NPI: 1215860861
Provider Name (Legal Business Name): JONATHAN R DAVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 CASTLE POINT ROAD PROSTHETICS
WAPPINGERS FALLS NY
12590-7004
US

IV. Provider business mailing address

41 CASTLE POINT ROAD PROSTHETICS
WAPPINGERS FALLS NY
12590-7004
US

V. Phone/Fax

Practice location:
  • Phone: 845-831-2000
  • Fax:
Mailing address:
  • Phone: 845-831-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: