Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 221990 | NY |
NPI | 1043428204 |
---|---|
Provider Name | Dr. Valentin Pardo Jovellanos |
First Address | Blauvelt, NY 10913-1331 |
Second Address | New York, NY 10040-1654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02177484 | (05) | NY |