Provider Demographics
NPI:1407947351
Name:CRYER, JONATHAN ERIC (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ERIC
Last Name:CRYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ASCOT PLACE
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-266-0772
Mailing Address - Fax:
Practice Address - Street 1:2 ASCOT PLACE
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-266-0772
Practice Address - Fax:607-266-0176
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235337207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02668037Medicaid
NYI34842Medicare UPIN
NYRA7367Medicare PIN