Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 209097 | NY |
NPI | 1013010677 |
---|---|
Provider Name | Fernando Ongkingco |
First Address | Watertown, NY 13601-4001 |
Second Address | Watertown, NY 13601-4001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01644917 | (05) | NY |
G50219 | (02) |