Healthcare Provider Details

I. General information

NPI: 1134151798
Provider Name (Legal Business Name): JOSE G TIONGSON JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E RIDLEY AVE
RIDLEY PARK PA
19078-3025
US

IV. Provider business mailing address

103 E RIDLEY AVE
RIDLEY PARK PA
19078-3025
US

V. Phone/Fax

Practice location:
  • Phone: 610-532-4233
  • Fax: 610-522-9368
Mailing address:
  • Phone: 610-532-4233
  • Fax: 610-522-9368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD034421L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: