Provider Demographics
NPI:1588293682
Name:OENTORO, JAYMIE EUREKO (MD)
Entity type:Individual
Prefix:MR
First Name:JAYMIE
Middle Name:EUREKO
Last Name:OENTORO
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 1:101 NICOLIS ROAD
Mailing Address - Street 2:STONY BROOK UNIVERSITY HOSPITAL, DEPARTMENT OF PATHOLOG
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-7025
Mailing Address - Country:US
Mailing Address - Phone:631-444-2224
Mailing Address - Fax:
Practice Address - Street 1:101 NICOLIS ROAD
Practice Address - Street 2:STONY BROOK UNIVERSITY HOSPITAL, DEPARTMENT OF PATHOLOG
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-7025
Practice Address - Country:US
Practice Address - Phone:631-444-2224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2023-11-08
Deactivation Date:2020-12-08
Deactivation Code:
Reactivation Date:2023-11-08
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program