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General NPI Number Information
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NPI Number | 1134352024
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Entity Type | Organization
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Legal Business Name | ANDREW JACONO MD PLLC
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Dates
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Enumeration Date | 08/26/2009
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Last Update Date | 08/26/2009
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Provider Practice Location Address
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Address Line | 440 NORTHERN BLVD
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City | GREAT NECK
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State | NY
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Zip | 11021-4813
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Country | US
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Telephone | 516-773-4646
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Fax | 516-773-1360
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Provider Business Mailing Address
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Address Line | 440 NORTHERN BLVD
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City | GREAT NECK
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State | NY
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Zip | 11021-4813
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Country | US
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Telephone | 516-773-4646
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Fax | 516-773-1360
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ANDREW ANGELO JACONO
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Credential | M.D.
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Telephone | 516-773-4646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State |
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