Individual
JONATHON THOMAS HAVERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
20 PROSPECT AVE, HACKENSACK, NJ 07601-1997
(201) 996-2222
Mailing address
30 PROSPECT AVE, HACKENSACK, NJ 07601-1915
(201) 996-2222
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
25MB11428200
NJ
207P00000X
Emergency Medicine Physician
309053
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/26/2018
Last updated
06/23/2022
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