Provider Demographics
NPI:1386726230
Name:DUNGO, JOVEN P (MD)
Entity type:Individual
Prefix:DR
First Name:JOVEN
Middle Name:P
Last Name:DUNGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 477 MONTGOMERY STREET
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07303
Mailing Address - Country:US
Mailing Address - Phone:201-653-1144
Mailing Address - Fax:201-653-6104
Practice Address - Street 1:205 9TH STREET
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302
Practice Address - Country:US
Practice Address - Phone:201-653-1144
Practice Address - Fax:201-653-6104
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04298200207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ118041Medicaid
NJ450454Medicare ID - Type Unspecified
NJC55081Medicare UPIN