Individual
JONATHAN REID BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
622 W 168TH ST, NEW YORK, NY 10032-3720
(646) 951-1086
Mailing address
622 W 168TH ST PH 16, NEW YORK, NY 10032-3720
Taxonomy
Speciality
Code
Description
License number
State
2084P0015X
Psychosomatic Medicine Physician
Primary
335155
NY
Other
Enumeration date
03/26/2021
Last updated
07/09/2025
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