Provider Demographics
NPI:1699181354
Name:GYNECOLOGY ON JUNCTION, P.C.
Entity Type:Organization
Organization Name:GYNECOLOGY ON JUNCTION, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSENDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ICOCHEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-656-2312
Mailing Address - Street 1:4023A JUNCTION BLVD
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2123
Mailing Address - Country:US
Mailing Address - Phone:718-626-2312
Mailing Address - Fax:
Practice Address - Street 1:4023A JUNCTION BLVD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2123
Practice Address - Country:US
Practice Address - Phone:718-626-2312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty