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General NPI Number Information
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NPI Number | 1760612725
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Entity Type | Individual
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Provider Name | JONATHAN JOSEPH DETRIXHE M.A.
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Gender | Male
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Dates
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Enumeration Date | 07/23/2009
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Last Update Date | 10/07/2010
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Provider Practice Location Address
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Address Line | 635 W 165TH ST 6TH FLR
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City | NEW YORK
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State | NY
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Zip | 10032-3724
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Country | US
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Telephone | 212-305-4666
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Fax |
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Provider Business Mailing Address
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Address Line | 635 WEST 165TH STREET, 6TH FLOOR NEW YORK PRESBYTERIAN HOSPITAL
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City | NEW YORK
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State | NY
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Zip | 10032
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Country | US
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Telephone | 212-305-4666
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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