Provider Demographics
NPI:1588728992
Name:JONGCO, BIENVENIDO R (MD)
Entity type:Individual
Prefix:
First Name:BIENVENIDO
Middle Name:R
Last Name:JONGCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:451 CLARKSON AVE
Mailing Address - Street 2:ROOM B4104-A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2054
Mailing Address - Country:US
Mailing Address - Phone:718-245-4079
Mailing Address - Fax:718-245-3011
Practice Address - Street 1:451 CLARKSON AVE
Practice Address - Street 2:ROOM B4104-A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2054
Practice Address - Country:US
Practice Address - Phone:718-245-4079
Practice Address - Fax:718-245-3011
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2013-06-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1151712086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1876503Medicaid
NJ1876503Medicaid
NJD98942Medicare UPIN
D98942Medicare UPIN