Basic Information
| Provider Information | |||||||||
| NPI: | 1720285349 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUTERMAN | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | GLENN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 405 19TH ST S | ||||||||
| Address2: | |||||||||
| City: | BRIGANTINE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082032027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9179028169 | ||||||||
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| Practice Location | |||||||||
| Address1: | SUNY STONY BRK | ||||||||
| Address2: | T12-020 HEALTH SCIENCES CENTER | ||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117948121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314442599 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2007 | ||||||||
| LastUpdateDate: | 05/03/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084V0102X | 25 MA 09394700 | NJ | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Vascular Neurology | 2084V0102X | 266135 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Vascular Neurology |
No ID Information.