MEDICARE: MR. JONAH D SHATKIN

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	146N00000X	Basic Emergency Medical Technician	549920	NY

General Provider Information

NPI Number	:	1790633642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JONAH D SHATKIN

Provider Business Mailing Address
First Line	:	17 MARISA DR
Second Line	:
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-1006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 MARISA DR
Second Line	:
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-1006
Country	:	US
Telephone Number	:	845-598-1993
Fax Number	:

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

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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