Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 182018 | NY |
Y | 2080A0000X | Adolescent Medicine | 182018-1 | NY |
NPI | 1114090818 |
---|---|
Provider Name | Louise Marie Jovino |
First Address | Nyack, NY 10960-1627 |
Second Address | Bardonia, NY 10954-1646 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 31/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F70828 | (02) | NY |