Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 200519 | NY |
N | 207NP0225X | Pediatric Dermatologist | 200519 | NY |
N | 208000000X | Pediatrician | 200519 | NY |
N | 2080A0000X | Adolescent Medicine | 200519-1 | NY |
NPI | 1093783367 |
---|---|
Provider Name | Dr. Jonathan David Kurt Trager |
First Address | Great Neck, NY 11023-2131 |
Second Address | Great Neck, NY 11021-1126 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2006 |
Last Update Date | 21/12/2007 |