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General NPI Number Information
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NPI Number | 1184621906
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Entity Type | Individual
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Provider Name | JONATHAN PAUL SUMBER DPM
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Gender | Male
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 11/17/2009
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Provider Practice Location Address
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Address Line | 190 FAIR ST
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City | KINGSTON
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State | NY
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Zip | 12401-4502
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Country | US
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Telephone | 845-331-0601
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Fax | 845-331-0601
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Provider Business Mailing Address
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Address Line | PO BOX 3451
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City | KINGSTON
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State | NY
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Zip | 12402-3451
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Country | US
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Telephone | 845-331-0601
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Fax | 845-331-0601
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | N004351-1
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License Number State | NY
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