Active NPI
Jonathan Logan, M.D.
- Allergy Physician
- Canandaigua, NY
National Provider Identifier
1609871573
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Allergy Physician
- License
- 089645
- Practice address
- 201 Parrish St
Canandaigua, NY 14424-1727 - Phone
- (585) 394-6070
- NPI assigned
- Jun 16, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Allergy Physician | 207KA0200X | 089645 | NY | Primary |
Addresses
Primary practice location
201 Parrish St
Canandaigua, NY 14424-1727
Mailing address
201 Parrish St
Canandaigua, NY 14424-1727
Phone (585) 394-6070
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P010089546 | Other | NY | EXCELLUS BLUE CHOICE |
| 1360 | Other | NY | EXCELLUS BLUE SHIELD |
| 100497AA | Other | NY | PREFERRED CARE AL |
| 00025452201 | Other | NY | UNIVERA |
| 030001160 | Other | NY | RAILROAD MEDICARE |
| 100497DT | Other | NY | PREFERRED CARE PA |
| 5176319 | Other | NY | AETNA |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 089645 | NY | MD | Allergy Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1264464000000",
"number": "1609871573",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 PARRISH ST",
"city": "CANANDAIGUA",
"state": "NY",
"postal_code": "144241727",
"telephone_number": "585-394-6070",
"fax_number": "585-394-3068"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 PARRISH ST",
"city": "CANANDAIGUA",
"state": "NY",
"postal_code": "144241727",
"telephone_number": "585-394-6070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOGAN",
"first_name": "JONATHAN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-06-16",
"last_updated": "2010-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "207KA0200X",
"taxonomy_group": "",
"desc": "Allergy & Immunology, Allergy",
"state": "NY",
"license": "089645",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EXCELLUS BLUE CHOICE",
"identifier": "P010089546",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EXCELLUS BLUE SHIELD",
"identifier": "1360",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED CARE AL",
"identifier": "100497AA",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNIVERA",
"identifier": "00025452201",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "030001160",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED CARE PA",
"identifier": "100497DT",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "5176319",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Canandaigua, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.