Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 26NJ00680000 | NJ |
NPI | 1235675596 |
---|---|
Provider Name | Joanne Payongayong |
First Address | Paramus, NJ 07652-4251 |
Second Address | Ridgewood, NJ 07450-2726 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2017 |
Last Update Date | 11/01/2017 |