Provider Demographics
NPI:1891840658
Name:GETREU, JONATHAN SCOTT (MA CCC-A)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:SCOTT
Last Name:GETREU
Suffix:
Gender:M
Credentials:MA CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 DEER VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1567
Mailing Address - Country:US
Mailing Address - Phone:631-979-1999
Mailing Address - Fax:
Practice Address - Street 1:2143A WILLIAMSBRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-792-4327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1700237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
P32025Medicare UPIN
NYM70551Medicare ID - Type Unspecified