NPIMap

Individual provider Active NPI

Jonathan Wahl, M.D.

  • General Practice Physician
  • Jericho, NY
National Provider Identifier
1821155755
Registry record updated Nov 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
232419 Issued in NY
Practice address
471 N Broadway
Suite 278
Jericho, NY 11753-2106
Phone
(516) 695-6340
Fax
(718) 368-0400
NPI assigned
Jan 2, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 232419 NY Primary

Addresses

Primary practice location

471 N Broadway
Suite 278
Jericho, NY 11753-2106

Mailing address

471 N Broadway
Suite 278
Jericho, NY 11753-2106
Phone (516) 695-6340

Other identifiers 1

IdentifierTypeStateIssuer
02848373MedicaidNY

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

LicenseStateTypeSpecialty
232419NYMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Collins Wellcare Medical, P.C. Past Accepting new patients
SVS Wellcare Medical PLLC Past Accepting new patients
SZS Medical Care PLLC Past Accepting new patients
Parkway Medical PLLC Past Accepting new patients
Provider Medical Care PC Past Accepting new patients

Organizations & group practices 5

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": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257206400000",
    "number": "1821155755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "471 N BROADWAY",
            "address_2": "SUITE 278",
            "city": "JERICHO",
            "state": "NY",
            "postal_code": "117532106",
            "telephone_number": "516-695-6340",
            "fax_number": "718-368-0400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "471 N BROADWAY",
            "address_2": "SUITE 278",
            "city": "JERICHO",
            "state": "NY",
            "postal_code": "117532106",
            "telephone_number": "516-695-6340",
            "fax_number": "718-368-0400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAHL",
        "first_name": "JONATHAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-02",
        "last_updated": "2009-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NY",
            "license": "232419",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02848373",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jericho, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2009; 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.