Provider Demographics
NPI:1902806110
Name:LOK, JONAT (DPM)
Entity Type:Individual
Prefix:DR
First Name:JONAT
Middle Name:
Last Name:LOK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1906
Mailing Address - Country:US
Mailing Address - Phone:718-321-8395
Mailing Address - Fax:866-596-9505
Practice Address - Street 1:13347 SANFORD AVE STE 2C
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5816
Practice Address - Country:US
Practice Address - Phone:718-321-8395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN5854213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02264226Medicaid
NYPJ9172OtherBLUE CROSS BLUE SHIELD
NYP2937864OtherOXFORD
NY7094650OtherAETNA
NY463968POtherHIP
NYPJ9172OtherBLUE CROSS BLUE SHIELD
NY7094650OtherAETNA