Basic Information
Provider Information
NPI: 1295960441
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AUSTRIAN
FirstName: JONATHAN
MiddleName: S
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 462 1ST AVE
Address2: OLD BELLEVUE, 6TH FLOOR, ROOM A619
City: NEW YORK
State: NY
PostalCode: 100169196
CountryCode: US
TelephoneNumber: 2122633921
FaxNumber:  
Practice Location
Address1: 550 1ST AVE
Address2:  
City: NEW YORK
State: NY
PostalCode: 100166402
CountryCode: US
TelephoneNumber: 2122637300
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/18/2009
LastUpdateDate: 08/09/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/09/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X252949NYY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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