Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 115171 | NY |
NPI | 1588728992 |
---|---|
Provider Name | Bienvenido R. Jongco |
First Address | Brooklyn, NY 11203-2054 |
Second Address | Brooklyn, NY 11203-2054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 18/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1876503 | (05) | NJ |
D98942 | (02) | |
D98942 | (02) | NJ |