Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 060766 | NY |
NPI | 1003305665 |
---|---|
Provider Name | Jonathan Dov Hochbaum |
First Address | West Hempstead, NY 11552-3407 |
Second Address | Middletown, NY 10940-6570 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2018 |
Last Update Date | 12/12/2019 |