Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 141510 | NY |
N | 2080P0204X | Pediatric Emergency Doctor | 141510 | NY |
NPI | 1194759605 |
---|---|
Provider Name | Concepcion Pineda Songco |
First Address | Elmhurst, NY 11373-1329 |
Second Address | Elmhurst, NY 11373-1329 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 23/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00778501 | (05) | NY |
D03968 | (02) | NY |