Individual provider Active NPI

Jonathan Shea Degorter, D.C.

  • Chiropractor
  • Syosset, NY
National Provider Identifier
1053657643
Registry record updated Mar 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
X012214-1 Issued in NY
Practice address
99 Cold Spring Rd Ste 102a
Syosset, NY 11791-3140
Phone
(516) 921-1295
Fax
(516) 496-2860
NPI assigned
Dec 31, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 10, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X X012214-1 NY Primary

Addresses

Primary practice location

99 Cold Spring Rd Ste 102a
Syosset, NY 11791-3140

Mailing address

99 Cold Spring Rd Ste 102a
Syosset, NY 11791-3140
Phone (516) 921-1295

Other practice location 1

33 Queens St
Syosset, NY 11791-3063
Phone (516) 921-1295

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
X012214-1NYMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Cold Spring Chiropractic Chiropractor CurrentSince Jul 24, 2022 Accepting new patients
Jonas Chiropractic Sports Injury Care Chiropractor CurrentSince Mar 13, 2022 Accepting new patients

Locations

99 Cold Spring Rd
Ste 102A
Syosset, NY 11791
Phone (516) 921-1295

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1356912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646870400000",
    "number": "1053657643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 COLD SPRING RD STE 102A",
            "city": "SYOSSET",
            "state": "NY",
            "postal_code": "117913140",
            "telephone_number": "516-921-1295",
            "fax_number": "516-496-2860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 COLD SPRING RD STE 102A",
            "city": "SYOSSET",
            "state": "NY",
            "postal_code": "117913140",
            "telephone_number": "516-921-1295",
            "fax_number": "516-496-2860"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "33 Queens St",
            "address_purpose": "LOCATION",
            "city": "Syosset",
            "state": "NY",
            "postal_code": "117913063",
            "country_code": "US",
            "telephone_number": "516-921-1295",
            "fax_number": "516-496-2860",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEGORTER",
        "first_name": "JONATHAN",
        "middle_name": "SHEA",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-12-31",
        "last_updated": "2022-03-10",
        "certification_date": "2022-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "X012214-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syosset, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.