Provider Demographics
NPI:1518004993
Name:POTACK, JONATHAN ZACHARY (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ZACHARY
Last Name:POTACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5 E 98TH ST
Mailing Address - Street 2:11TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6501
Mailing Address - Country:US
Mailing Address - Phone:212-241-4299
Mailing Address - Fax:212-426-5099
Practice Address - Street 1:5 E 98TH ST
Practice Address - Street 2:11TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6501
Practice Address - Country:US
Practice Address - Phone:212-241-4299
Practice Address - Fax:212-426-5099
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY228954207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology