Provider Demographics
NPI:1720285349
Name:GUTERMAN, JONATHAN GLENN (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:GLENN
Last Name:GUTERMAN
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:405 19TH ST S
Mailing Address - Street 2:
Mailing Address - City:BRIGANTINE
Mailing Address - State:NJ
Mailing Address - Zip Code:08203-2027
Mailing Address - Country:US
Mailing Address - Phone:917-902-8169
Mailing Address - Fax:
Practice Address - Street 1:332 E 14TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4243
Practice Address - Country:US
Practice Address - Phone:212-481-3333
Practice Address - Fax:212-253-4242
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2661352084V0102X
NJ25 MA 093947002084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology