Provider Demographics
NPI:1134133127
Name:JOVEN, PEDRO G (MD)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:G
Last Name:JOVEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 GEORGE URBAN BLVD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-3004
Mailing Address - Country:US
Mailing Address - Phone:716-895-6826
Mailing Address - Fax:716-895-1397
Practice Address - Street 1:162 GEORGE URBAN BLVD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-3004
Practice Address - Country:US
Practice Address - Phone:716-895-6826
Practice Address - Fax:716-895-1397
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104946207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010085601OtherUNIVERA
NY0408463OtherINDEPENDENT HEALTH
NY5028782OtherBLUE CROSS OF WNY
B71215Medicare UPIN
NY028782Medicare ID - Type Unspecified
NY5028782OtherBLUE CROSS OF WNY