MEDICARE: DR. JONATHAN DAVID MD

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	207RG0100X	Gastroenterology Physician	178695	NY

General Provider Information

NPI Number	:	1922004241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN DAVID MD

Provider Business Mailing Address
First Line	:	136 SAGAMORE RD
Second Line	:
City	:	TUCKAHOE
State	:	NY
Zip	:	10707-4009
Country	:	US
Telephone Number	:	914-337-6400
Fax Number	:	914-337-8019

Provider Business Practice Location Address
First Line	:	136 SAGAMORE RD
Second Line	:
City	:	TUCKAHOE
State	:	NY
Zip	:	10707-4009
Country	:	US
Telephone Number	:	914-337-6400
Fax Number	:	914-337-8019

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/29/2010

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