Individual
JONATHAN MARK KOROSTOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3400 SPRUCE ST, 5 WHITE BUILDING, PHILADELPHIA, PA 19104-4206
(215) 662-3580
Mailing address
3400 SPRUCE ST, 5 WHITE BUIDING, PHILADELPHIA, PA 19104-4206
(215) 662-3580
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
DS024789L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014770200001
—
PA
Enumeration date
06/27/2006
Last updated
04/02/2013
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