Healthcare Provider Details

I. General information

NPI: 1114090818
Provider Name (Legal Business Name): LOUISE MARIE JOVINO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

446 ROUTE 304 STE E #105
BARDONIA NY
10954-1646
US

IV. Provider business mailing address

265 N. HIGHLAND AVE #105
NYACK NY
10960-1627
US

V. Phone/Fax

Practice location:
  • Phone: 845-623-8031
  • Fax: 845-624-0928
Mailing address:
  • Phone: 845-358-5437
  • Fax: 845-358-6120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number182018
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number182018-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: