Provider Demographics
NPI:1114185584
Name:PEDRO G JOVEN MD PC
Entity Type:Organization
Organization Name:PEDRO G JOVEN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:G
Authorized Official - Last Name:JOVEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-895-6826
Mailing Address - Street 1:162 GEORGE URBAN BLVD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-3004
Mailing Address - Country:US
Mailing Address - Phone:716-895-6826
Mailing Address - Fax:716-895-1397
Practice Address - Street 1:162 GEORGE URBAN BLVD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-3004
Practice Address - Country:US
Practice Address - Phone:716-895-6826
Practice Address - Fax:716-895-1397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-01
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104946261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB71215Medicare UPIN
NYBA1467Medicare PIN