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NPI Code Detail

MEDICARE: JONATHAN DOV HOCHBAUM

MEDICARE: JONATHAN DOV HOCHBAUM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2122300000XDentist060766NY

General Provider Information

NPI Number : 1003305665
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN DOV HOCHBAUM
Provider Business Mailing Address
First Line : 686 EVERGREEN DR
Second Line :
City : WEST HEMPSTEAD
State : NY
Zip : 11552-3407
Country : US
Telephone Number : 516-993-5178
Fax Number :
Provider Business Practice Location Address
First Line : 225 DOLSON AVE STE 202
Second Line :
City : MIDDLETOWN
State : NY
Zip : 10940-6570
Country : US
Telephone Number : 845-343-1486
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2018
Last Update Date : 12/12/2019

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Directions to “ JONATHAN DOV HOCHBAUM ” Practice Location

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