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General NPI Number Information
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NPI Number | 1649702416
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Entity Type | Individual
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Provider Name | JONATHAN FLOREZ
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Gender | Male
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Dates
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Enumeration Date | 03/31/2017
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Last Update Date | 07/29/2020
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Provider Practice Location Address
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Address Line | 1623 WEIRFIELD ST
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City | RIDGEWOOD
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State | NY
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Zip | 11385-5349
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Country | US
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Telephone | 718-456-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 288 KISSEL AVE APT 5P
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City | STATEN ISLAND
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State | NY
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Zip | 10310-1648
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Country | US
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Telephone | 401-999-3189
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 306361-01
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License Number State | NY
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