MEDICARE: JONATHON CHARLES WENKE FNP

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
1	363LF0000X	Family Nurse Practitioner	344101	NY

General Provider Information

NPI Number	:	1124681242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHON CHARLES WENKE FNP

Provider Business Mailing Address
First Line	:	1 E ROE BLVD
Second Line	:
City	:	PATCHOGUE
State	:	NY
Zip	:	11772-2631
Country	:	US
Telephone Number	:	631-475-3900
Fax Number	:	631-475-5166

Provider Business Practice Location Address
First Line	:	375 E MAIN ST STE 26
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-8418
Country	:	US
Telephone Number	:	631-891-6200
Fax Number	:	631-350-7803

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2019
Last Update Date	:	05/06/2026

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