Individual
JONATHAN THOMAS HUMPHREYS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPA-C
Contact information
Practice address
45 READE PL, POUGHKEEPSIE, NY 12601-3947
(845) 721-6466
Mailing address
78 MORNINGSIDE DR, PATTERSON, NY 12563-2308
(845) 721-6466
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
014578-1
NY
Other
Enumeration date
05/13/2011
Last updated
05/13/2011
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