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NPI Code Detail

MEDICARE: JONATHAN BEACH DO PLLC

MEDICARE: JONATHAN BEACH DO PLLC
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
1261QU0200XUrgent Care Clinic/Center228601NY

General Provider Information

NPI Number : 1104023910
Entity Type Code : Organization
Provider Name (Legal Business Name) : JONATHAN BEACH DO PLLC
Provider Business Mailing Address
First Line : 505 DEVILS DEN RD
Second Line :
City : ALTONA
State : NY
Zip : 12910-2018
Country : US
Telephone Number : 518-236-5611
Fax Number :
Provider Business Practice Location Address
First Line : 79 HAMMOND LN
Second Line : SUITE #2
City : PLATTSBURGH
State : NY
Zip : 12901-2008
Country : US
Telephone Number : 518-563-5900
Fax Number : 519-563-5903
Authorized Official
Title or Position : PRESIDENT
Name : DR. JONATHAN CHARLES BEACH
Credential : DO
Telephone Number : 518-563-5900
Provider Enumeration Date : 06/27/2007
Last Update Date : 08/22/2020

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