Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 233348 | NY |
NPI | 1033131586 |
---|---|
Provider Name | Dr. Jorge Venegas |
First Address | New York, NY 10037-1802 |
Second Address | New York, NY 10037-1802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02607734 | (05) | NY |