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General NPI Number Information
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NPI Number | 1972882850
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Entity Type | Organization
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Legal Business Name | JBA WOMEN'S MEDICAL PC
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Dates
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Enumeration Date | 08/10/2011
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | 129 URBAN ST
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City | MOUNT VERNON
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State | NY
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Zip | 10552-3211
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Country | US
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Telephone | 914-699-2659
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Fax | 914-699-2659
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Provider Business Mailing Address
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Address Line | 129 URBAN ST
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City | MOUNT VERNON
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State | NY
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Zip | 10552-3211
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Country | US
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Telephone | 914-699-2659
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Fax | 914-699-2659
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/CEO
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Name | JONELLE M BINGHAM
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Credential | M.D.
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Telephone | 914-699-2659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 230893
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License Number State | NY
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