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General NPI Number Information
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NPI Number | 1801395801
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Entity Type | Individual
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Provider Name | JONATHAN MARC ISON PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/05/2018
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Last Update Date | 01/03/2024
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Provider Practice Location Address
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Address Line | 1111 AMSTERDAM AVE
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City | NEW YORK
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State | NY
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Zip | 10025-1716
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Country | US
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Telephone | 212-636-3375
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Fax |
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Provider Business Mailing Address
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Address Line | 1 PINE ST
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City | LAKE GROVE
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State | NY
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Zip | 11755-2721
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Country | US
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Telephone | 631-574-7466
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 021777-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 021777-1
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License Number State | NY
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