Provider Demographics
NPI:1144279977
Name:EMERTON, JON A (MD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:A
Last Name:EMERTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 FACTORY ST
Mailing Address - Street 2:PO BOX 91
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2729
Mailing Address - Country:US
Mailing Address - Phone:315-782-4207
Mailing Address - Fax:315-782-8699
Practice Address - Street 1:428 WASHINGTON ST
Practice Address - Street 2:STE 4
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4832
Practice Address - Country:US
Practice Address - Phone:315-788-4880
Practice Address - Fax:315-788-4896
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227318207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00354315Medicaid
NY00354315Medicaid