Provider Demographics
NPI:1790778603
Name:JONGCO, ANITA O (MD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:O
Last Name:JONGCO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:120 MILLBURN AVE
Mailing Address - Street 2:STE M3
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1942
Mailing Address - Country:US
Mailing Address - Phone:973-912-8400
Mailing Address - Fax:973-912-0099
Practice Address - Street 1:120 MILLBURN AVE
Practice Address - Street 2:STE M3
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1942
Practice Address - Country:US
Practice Address - Phone:973-912-8400
Practice Address - Fax:973-912-0099
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
NJMA30422207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3008207Medicaid
NJAJ9568265OtherDEA
NJAJ9568265OtherDEA
NJ3008207Medicaid