MEDICARE: JONATHAN ERIC OKON DMD

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	1223G0001X	General Practice Dentistry	049-245	NY
2	1223G0001X	General Practice Dentistry	DN 20180-1	MA

General Provider Information

NPI Number	:	1982820585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN ERIC OKON DMD

Provider Business Mailing Address
First Line	:	47 BRACKETT RD
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02458-2611
Country	:	US
Telephone Number	:	617-964-7375
Fax Number	:

Provider Business Practice Location Address
First Line	:	133 E 58TH ST STE 807
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-1122
Country	:	US
Telephone Number	:	212-380-1165
Fax Number	:

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

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	07/08/2007

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