Provider Demographics
NPI:1386894244
Name:DAVIDSON, JAN KENNETH (MD PHD)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:KENNETH
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:DR
Other - First Name:JAN
Other - Middle Name:KENNETH
Other - Last Name:DAVIDSON-MONCADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD PHD
Mailing Address - Street 1:1230 YORK AVE # 39
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6307
Mailing Address - Country:US
Mailing Address - Phone:212-327-7858
Mailing Address - Fax:212-327-7319
Practice Address - Street 1:1230 YORK AVE # 39
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6307
Practice Address - Country:US
Practice Address - Phone:212-327-7858
Practice Address - Fax:212-327-7319
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250568282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital