Korostoff, Jonathan Mark
Korostoff, Jonathan Mark is an individual health care provider with primary practice located at 3400 Spruce St 5 White Building, Philadelphia PA 19104-4206. He recently has only one registered license in Dental Providers / Periodontics, which is considered as his primary health care specialty. Korostoff, Jonathan Mark can be contacted via phone (215) 662-3580.Contact Information
Primary practice address
3400 Spruce St 5 White Building
Philadelphia PA 19104-4206
Phone: (215) 662-3580
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Periodontics | 1223P0300X | DS024789L | Pennsylvania |
Profile Details
| NPI number | 1154358042 |
|---|---|
| LBN Legal business name | Korostoff, Jonathan Mark |
| Credentials | Doctor of Dental Medicine (DMD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 27th, 2006 |
| Last updated | Apr 2nd, 2013 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1154358042 | NPPES |
| Pennsylvania | MEDICAID | 0014770200001 |
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