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General NPI Number Information
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NPI Number | 1114380383
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Entity Type | Organization
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Legal Business Name | CROWN NEUROLOGY, P.C.
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Dates
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Enumeration Date | 04/04/2016
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Last Update Date | 04/04/2016
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Provider Practice Location Address
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Address Line | 1181 WOODROW RD
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City | STATEN ISLAND
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State | NY
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Zip | 10309-1723
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Country | US
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Telephone | 917-902-8169
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Fax |
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Provider Business Mailing Address
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Address Line | 405 19TH ST S
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City | BRIGANTINE
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State | NJ
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Zip | 08203-2027
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Country | US
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Telephone | 917-902-8169
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Fax |
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Authorized Official
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Title or Position | M.D./OWNER
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Name | DR. JONATHAN GLENN GUTERMAN
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Credential | M.D.
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Telephone | 917-902-8169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 266135-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 266135-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2084V0102X
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Taxonomy Name | Vascular Neurology Physician
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License Number | 266135-1
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License Number State | NY
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