Provider Demographics
NPI:1043489339
Name:KANEGSON, JONATHAN LEONARD (PSYD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:LEONARD
Last Name:KANEGSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 E 88TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-0907
Mailing Address - Country:US
Mailing Address - Phone:646-634-5080
Mailing Address - Fax:
Practice Address - Street 1:19 W 34TH ST
Practice Address - Street 2:SOCIOMETRIC INSTITUTE- PH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3006
Practice Address - Country:US
Practice Address - Phone:212-947-7111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CA21681103TC0700X
MA8810103TC0700X
FLPY9535103TC0700X
NY017102103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
435284OtherMHN
NY10433489339OtherVALUE OPTIONS
NYV60A61OtherEMPIRE/BLUE CROSS BLUE SHIELD
NY$$$$$$$$$OtherCORPS HEALTH/HUMANA
NY03064995Medicaid
NY11301OtherMAGNACARE
435284OtherMHN
NY10433489339OtherVALUE OPTIONS