MEDICARE: DR. JONATHAN BRETT OVERDEVEST MD, PHD

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	207Y00000X	Otolaryngology Physician	295290	NY

General Provider Information

NPI Number	:	1881945657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN BRETT OVERDEVEST MD, PHD

Provider Business Mailing Address
First Line	:	180 FORT WASHINGTON AVE.
Second Line	:	HARKNESS PAVILION, 8TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10032-2200
Country	:	US
Telephone Number	:	212-305-8555
Fax Number	:	212-305-3975

Provider Business Practice Location Address
First Line	:	180 FORT WASHINGTON AVE.
Second Line	:	HARKNESS PAVILION, 7TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10032-1003
Country	:	US
Telephone Number	:	212-305-8555
Fax Number	:	212-305-3975

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

Provider Enumeration Date	:	09/19/2012
Last Update Date	:	09/28/2018

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