Provider Demographics
NPI:1770741621
Name:NEMAN, JONATHAN C (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:C
Last Name:NEMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1719
Mailing Address - Country:US
Mailing Address - Phone:516-773-4554
Mailing Address - Fax:516-466-4244
Practice Address - Street 1:64 BAYVIEW AVE
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1719
Practice Address - Country:US
Practice Address - Phone:516-773-4554
Practice Address - Fax:516-466-4244
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY054472122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program