Individual
JONATHAN DISSIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5401 OLD YORK RD, SUITE 300, PHILADELPHIA, PA 19141-3030
(215) 456-7190
(215) 456-7308
Mailing address
101 EAST OLNEY AVENUE, SUITE 400, PHILADELPHIA, PA 19120
(215) 456-7000
(215) 456-7308
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
MD039553L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001615708003
—
PA
Enumeration date
03/27/2006
Last updated
08/04/2015
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