Provider Demographics
NPI:1114090818
Name:JOVINO, LOUISE MARIE (DO)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:MARIE
Last Name:JOVINO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 N. HIGHLAND AVE
Mailing Address - Street 2:#105
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-1627
Mailing Address - Country:US
Mailing Address - Phone:845-358-5437
Mailing Address - Fax:845-358-6120
Practice Address - Street 1:446 ROUTE 304 STE E
Practice Address - Street 2:#105
Practice Address - City:BARDONIA
Practice Address - State:NY
Practice Address - Zip Code:10954-1646
Practice Address - Country:US
Practice Address - Phone:845-623-8031
Practice Address - Fax:845-624-0928
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182018208000000X
NY182018-12080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF70828Medicare UPIN