Provider Demographics
NPI:1316558596
Name:SHECTMAN, JONATHAN ADAR (NP)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ADAR
Last Name:SHECTMAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 626
Mailing Address - Street 2:
Mailing Address - City:GREAT RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11739-0626
Mailing Address - Country:US
Mailing Address - Phone:212-606-1166
Mailing Address - Fax:212-606-1109
Practice Address - Street 1:610 W 58TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1005
Practice Address - Country:US
Practice Address - Phone:212-606-1136
Practice Address - Fax:212-606-1109
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY356658363LF0000X
NY979934163WR0006X, 363LF0000X
ID65063363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health