Individual
JOE VONGVORACHOTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1790 BROADWAY, NEW YORK, NY 10019-1412
(212) 265-2828
Mailing address
1790 BROADWAY FL 10, NEW YORK, NY 10019-1412
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0116019442
VA
208100000X
Physical Medicine & Rehabilitation Physician
Primary
252770
NY
Other
Enumeration date
07/17/2007
Last updated
01/24/2014
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