Provider Demographics
NPI:1902978844
Name:ZUBIETA, JON-KAR (MD,PHD)
Entity Type:Individual
Prefix:
First Name:JON-KAR
Middle Name:
Last Name:ZUBIETA
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:JON
Other - Middle Name:K
Other - Last Name:ZUBIETA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:100 HIGHLANDS BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2320
Mailing Address - Country:US
Mailing Address - Phone:631-686-7921
Mailing Address - Fax:631-686-7972
Practice Address - Street 1:5 INTERVALE RD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1020
Practice Address - Country:US
Practice Address - Phone:734-330-9301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010532902084P0800X, 207U00000X
NY3016242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4371722Medicaid
MI4371722Medicaid
MIG53531Medicare UPIN