Provider Demographics
NPI:1760149207
Name:VO, PAULINE (PNP)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:VO
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 W 159TH ST APT 5E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-6863
Mailing Address - Country:US
Mailing Address - Phone:714-944-9888
Mailing Address - Fax:
Practice Address - Street 1:12314 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11419-2116
Practice Address - Country:US
Practice Address - Phone:718-843-8844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF383235-01208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty