Individual
MR. JONATHAN NIDOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
9 E MORELAND AVE, PHILADELPHIA, PA 19118-3512
(267) 254-4712
Mailing address
228 E BENEZET ST, PHILADELPHIA, PA 19118-4411
(267) 254-4712
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MSG001159
PA
Other
Enumeration date
03/15/2012
Last updated
03/15/2012
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