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General NPI Number Information
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NPI Number | 1053130724
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Entity Type | Individual
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Provider Name | MICHAEL JONAS
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Gender | Male
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Dates
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Enumeration Date | 10/09/2024
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 61 HILTON AVE STE 201
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City | GARDEN CITY
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State | NY
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Zip | 11530-2813
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Country | US
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Telephone | 516-798-4070
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Fax |
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Provider Business Mailing Address
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Address Line | 192 E 75TH ST APT 3C
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City | NEW YORK
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State | NY
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Zip | 10021-3243
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Country | US
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Telephone | 203-293-5124
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | P126219
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License Number State | NY
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