Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 027783 | NY |
NPI | 1063052017 |
---|---|
Provider Name | Pj Javellana Jamandre |
First Address | Bronx, NY 10469-4109 |
Second Address | Bronx, NY 10469-4109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2020 |
Last Update Date | 07/01/2020 |