Basic Information
| Provider Information | |||||||||
| NPI: | 1457589863 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TO | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3332 ROCHAMBEAU AVE | ||||||||
| Address2: | OB/GYN DEPARTMENT | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104672836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189206311 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3332 ROCHAMBEAU AVE | ||||||||
| Address2: | OB/GYN DEPARTMENT | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104672836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189206311 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2009 | ||||||||
| LastUpdateDate: | 06/24/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | 253521 | NY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
No ID Information.