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Jonathan Austin Deassis

Emergency Medicine

Allopathic & Osteopathic Physicians

101 Nicolls Rd Rm 80, Stony Brook, NY 11794-0001

PECOS Enrollment

This provider is enrolled in PECOS as JONATHAN DEASSIS.

Based on the most recent information from CMS, provider Jonathan Austin Deassis is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1689178980
Provider Type
Individual
Full Name
Deassis, Jonathan Austin
Title
Dr.
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
3/21/2018
Last Updated
5/20/2021

Contact Information

Practice Location

101 Nicolls Rd Rm 80, Stony Brook, NY 11794-0001

(631) 444-3880

(631) 444-3919

Mailing Location

289 Kramer Ave, Staten Island, NY 10309-4275

(347) 907-1776

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207P00000X Primary	Description Emergency Medicine Allopathic & Osteopathic Physicians	License 308087 New York
Code 390200000X	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer

Jonathan Austin Deassis

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

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Description

License

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