Provider Demographics
NPI:1407970783
Name:DENOBILE, JOANNA (PA)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:DENOBILE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 EDISON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2127
Mailing Address - Country:US
Mailing Address - Phone:718-823-3367
Mailing Address - Fax:718-653-2237
Practice Address - Street 1:3400 BAINBRIDGE AVENUE
Practice Address - Street 2:MMC - DEPT OF CT SURGERY
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011546363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant