Provider Demographics
NPI:1194968149
Name:JONAT LOK, DPM, PC
Entity type:Organization
Organization Name:JONAT LOK, DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONAT
Authorized Official - Middle Name:
Authorized Official - Last Name:LOK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:917-776-5127
Mailing Address - Street 1:29 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1906
Mailing Address - Country:US
Mailing Address - Phone:917-776-5127
Mailing Address - Fax:866-596-9505
Practice Address - Street 1:13347 SANFORD AVE STE 2C
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5816
Practice Address - Country:US
Practice Address - Phone:718-321-8395
Practice Address - Fax:866-596-9505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005854213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07569OtherGHI MEDICARE