Individual
DR. JONATHAN WAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
471 N BROADWAY, SUITE 278, JERICHO, NY 11753-2106
(516) 695-6340
(718) 368-0400
Mailing address
471 N BROADWAY, SUITE 278, JERICHO, NY 11753-2106
(516) 695-6340
(718) 368-0400
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
232419
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02848373
—
NY
Enumeration date
01/02/2007
Last updated
11/03/2009
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