Provider Demographics
NPI:1689178980
Name:DEASSIS, JONATHAN AUSTIN (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:AUSTIN
Last Name:DEASSIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:289 KRAMER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-4275
Mailing Address - Country:US
Mailing Address - Phone:347-907-1776
Mailing Address - Fax:
Practice Address - Street 1:101 NICOLLS RD RM 80
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-3880
Practice Address - Fax:631-444-3919
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY308087207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program