Provider Demographics
NPI:1427296177
Name:JAVITCH, JONATHAN A (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:A
Last Name:JAVITCH
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:630 W 168TH ST
Mailing Address - Street 2:CENTER FOR MOLECULAR RECOGNITION, P&S 11-401
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3725
Mailing Address - Country:US
Mailing Address - Phone:212-305-7308
Mailing Address - Fax:775-898-5133
Practice Address - Street 1:630 W 168TH ST
Practice Address - Street 2:CENTER FOR MOLECULAR RECOGNITION, P&S 11-401
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3725
Practice Address - Country:US
Practice Address - Phone:212-305-7308
Practice Address - Fax:775-898-5133
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1728902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry