Individual
DR. JONATHAN LOGAN
Active
Individual
DR. JONATHAN LOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
089645
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00025452201
UNIVERA
NY
01
—
030001160
RAILROAD MEDICARE
NY
01
—
100497AA
PREFERRED CARE AL
NY
01
—
100497DT
PREFERRED CARE PA
NY
01
—
1360
EXCELLUS BLUE SHIELD
NY
01
—
5176319
AETNA
NY
01
—
P010089546
EXCELLUS BLUE CHOICE
NY
Enumeration date
06/16/2005
Last updated
01/26/2010
Update your record
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