Provider Demographics
NPI:1750748760
Name:UYGONGCO, CONIE (DDT)
Entity type:Individual
Prefix:MRS
First Name:CONIE
Middle Name:
Last Name:UYGONGCO
Suffix:
Gender:F
Credentials:DDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2279 CONEY ISLAND AVE
Mailing Address - Street 2:2B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-3337
Mailing Address - Country:US
Mailing Address - Phone:718-998-9890
Mailing Address - Fax:718-998-9891
Practice Address - Street 1:2279 CONEY ISLAND AVE
Practice Address - Street 2:2B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-3337
Practice Address - Country:US
Practice Address - Phone:718-998-9890
Practice Address - Fax:718-998-9891
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032403-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist