Provider Demographics
NPI:1326606898
Name:SHIRMAN, JONATHAN E (DO)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:E
Last Name:SHIRMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 E 1ST ST APT 309F
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-2898
Mailing Address - Country:US
Mailing Address - Phone:818-322-5081
Mailing Address - Fax:
Practice Address - Street 1:3641 W 5TH ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-6424
Practice Address - Country:US
Practice Address - Phone:805-985-5505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY318974208D00000X
390200000X
NY390200000X
CA20A22896207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program