Provider Demographics
NPI:1942432562
Name:MWANDO, JOHN (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:MWANDO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W 15TH ST
Mailing Address - Street 2:APT 1 KS
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6700
Mailing Address - Country:US
Mailing Address - Phone:949-887-3924
Mailing Address - Fax:
Practice Address - Street 1:101 W 15TH ST
Practice Address - Street 2:APT 1 KS
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6700
Practice Address - Country:US
Practice Address - Phone:949-887-3924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN 006313-1213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery