Basic Information
| Provider Information | |||||||||
| NPI: | 1881692648 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOGEL | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | TAD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1345 RXR PLZ FL 13 | ||||||||
| Address2: | |||||||||
| City: | UNIONDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115561301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164530435 | ||||||||
| FaxNumber: | 6468463283 | ||||||||
| Practice Location | |||||||||
| Address1: | 1470 METROPOLITAN AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104627446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185719270 | ||||||||
| FaxNumber: | 7168597388 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 10/23/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | 248396 | NY | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 207P00000X | 248396 | NY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.