Provider Demographics
NPI:1629187836
Name:OSTROFF, JONATHAN E (DO)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:E
Last Name:OSTROFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-6335
Mailing Address - Country:US
Mailing Address - Phone:215-638-0666
Mailing Address - Fax:215-638-3320
Practice Address - Street 1:2966 STREET RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-2604
Practice Address - Country:US
Practice Address - Phone:215-638-0666
Practice Address - Fax:215-638-3320
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004426L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D98712Medicare UPIN