Provider Demographics
NPI:1174604219
Name:SHOCHAT, JONATHAN (LPO)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:SHOCHAT
Suffix:
Gender:M
Credentials:LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 W WOOLBRIGHT ROAOD
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-6634
Mailing Address - Country:US
Mailing Address - Phone:561-572-0305
Mailing Address - Fax:561-572-0348
Practice Address - Street 1:2609 W WOOLBRIGHT RD
Practice Address - Street 2:SUITE 3A
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-6634
Practice Address - Country:US
Practice Address - Phone:561-572-0305
Practice Address - Fax:561-572-0348
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR69222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Not Answered224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5690060001Medicare ID - Type Unspecified