DR. JEONTAIK JOHN KWON (NPI# 1225265861) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225265861 |
| Entity Type | Individual |
| Full Name | DR. JEONTAIK JOHN KWON |
| Credential | M.D. |
| Practice Address |
241 North Rd Poughkeepsie NY 12601-1154 |
| Mailing Address |
19 Bradhurst Ave Suite 3100n Hawthorne NY 10532-2140 |
| Practice Telephone | 8454835934 |
| Practice Fax Number | 8454835783 |
| Mailing Telephone | 9149099018 |
| Mailing Fax Number | 9149099028 |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2016-06-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208600000X | Surgery | MT194818 | PA | Allopathic & Osteopathic Physicians |
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
284362 | NY | Allopathic & Osteopathic Physicians |
| N | 2086S0129X |
Surgery Specialization: Vascular Surgery |
MD444812 | PA | Allopathic & Osteopathic Physicians |
| Street Address |
241 NORTH RD |
| City | POUGHKEEPSIE |
| State | NY |
| Zip Code | 12601-1154 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922006501 | Lobsang Lhungay | Anesthesiology | 241 North Rd, Poughkeepsie, NY 12601-1154 | 2005-07-08 |
| 1457958118 | Brian Lucas Kaczmarek | Registered Nurse | 241 North Rd, Poughkeepsie, NY 12601-1154 | 2020-10-06 |
| 1750988796 | Joshua John Foote | Registered Nurse | 241 North Rd, Poughkeepsie, NY 12601-1154 | 2020-10-02 |
| 1467079681 | Kwaku Baidoo | Registered Nurse | 241 North Rd, Poughkeepsie, NY 12601-1154 | 2020-07-03 |
| 1770106874 | Marissa Lyn Campilii | Physician Assistant | 241 North Rd, Poughkeepsie, NY 12601-1154 | 2020-05-22 |
| 1205468642 | Scott Peters | Registered Nurse | 241 North Rd, Poughkeepsie, NY 12601-1154 | 2020-02-04 |
| 1376199463 | William Martinez | Registered Nurse | 241 North Rd, Poughkeepsie, NY 12601-1154 | 2019-08-14 |
| 1710532908 | Annmarie Scalzo | Nurse Practitioner | 241 North Rd, Poughkeepsie, NY 12601-1154 | 2019-08-05 |
| 1568014793 | Lauren Davis | Physician Assistant | 241 North Rd, Poughkeepsie, NY 12601-1154 | 2019-07-09 |
| 1235791138 | Amanda Mae Frankie | Physician Assistant | 241 North Rd, Poughkeepsie, NY 12601-1154 | 2019-07-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194348425 | Hudson Valley Radiologists, PC | Radiology | 57 Kingwood Park, Poughkeepsie, NY 12601 | 2020-05-21 |
| 1063049088 | Jaquellah Taylor | Student in an Organized Health Care Education/Training Program | Vassar Brother Medical Center 45 Reade Place, Poughkeepsie, NY 12601 | 2020-03-27 |
| 1053957050 | Jasmine Syin-lan Miller | Student in an Organized Health Care Education/Training Program | 3399 North Road, Marist College Msc 12617, Poughkeepsie, NY 12601 | 2019-11-25 |
| 1144864224 | Kim Beverly | Technician | 16 Tamidan Road, Poughkeepsle, NY 12601 | 2019-11-01 |
| 1851852768 | Marwa H Abdalla | Student in an Organized Health Care Education/Training Program | Vassar Brother Medical Center, 45 Reade Place, Poughkeepsie, NY 12601 | 2019-03-26 |
| 1619459047 | Victoria Bozydaj | Occupational Therapy Assistant | 50 Rinaldi Boulevard Apt 7r, Poughkeepsie, NY 12601 | 2018-09-01 |
| 1821589953 | Avo Gregory Serafino | Physician Assistant | 228 Donnelly, Poughkeepsie, NY 12601 | 2018-05-24 |
| 1649771486 | Raewyn Kalisha Clayton | Registered Nurse | 31 Forbus Street Apt C2, Poughkeepsie, NY 12601 | 2018-02-27 |
| 1780108761 | Ronica Dorothy White | Licensed Practical Nurse | 7c Muldowney Circle, Poughkeepsie, NY 12601 | 2017-08-01 |
| 1336662048 | Ashley Elizabeth Travers | Licensed Practical Nurse | 100 Innis Ave, Poughkeepsie, NY 12601 | 2017-07-25 |
| Find all providers in zip 12601 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992276885 | Health Quest Medical Practice, PC | Surgery | 21 Reade Pl Ste 2200, Poughkeepsie, NY 12601-3970 | 2018-12-17 |
| 1275569808 | William E Bollengier | Surgery | 1 Columbia St, Ste 302, Poughkeepsie, NY 12601-3923 | 2006-06-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962003509 | Gs Medical, P.C. | Surgery | 377-b Pearsall Ave, Cedarhurst, NY 11516 | 2020-11-02 |
| 1073128971 | New York Vascular Group, Pllc | Surgery | 19 Laurel Ave Ste 102, Cornwall, NY 12518-1403 | 2020-09-09 |
| 1578190179 | Camilo Jose Martinez | Surgery | 23 S Howell Ave Ste H, Centereach, NY 11720-4445 | 2020-03-24 |
| 1407483399 | Interventional Medicine | Surgery | 1122a Coney Island Ave, Brooklyn, NY 11230-2307 | 2020-03-23 |
| 1487287975 | Syracuse Professional Medical Services of New York LLC | Surgery | 1101 Erie Blvd E Ste 201a, Syracuse, NY 13210-1144 | 2020-02-13 |
| 1457983181 | Syracuse Medical of New York LLC | Surgery | 1101 Erie Blvd E Ste 201b, Syracuse, NY 13210-1144 | 2020-02-11 |
| 1366914483 | Star Veins Centers PC | Surgery | 225 W 35th St Frnt 2, New York, NY 10001-1904 | 2018-12-31 |
| 1528547312 | Norwood Professional Medical Services of New York LLC | Surgery | 3487-89 Jerome Ave, Ste A, Bronx, NY 10468 | 2018-08-13 |
| 1336628130 | Norwood Medical of New York LLC | Surgery | 3487-89 Jerome Ave, Ste B, Bronx, NY 10468 | 2018-08-13 |
| 1003393299 | Bushwick Professional Medical Services of New York LLC | Surgery | 441 Knickerbocker Ave Ste A, Brooklyn, NY 11237-4508 | 2018-07-20 |
| Find all providers with the same taxonomy | ||||
| City | POUGHKEEPSIE |
| Zip Code | 12601 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.