Most Relevant Information
Provider Data
| NPI Number: | 1003268301 |
| Provider Name: | VINCENT SETIAWAN PRAWOKO MD |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/11/2016 |
| Last Updated: | 07/11/2016 |
Provider Practice Location
1650 GRAND CONCOURSE
BRONX
NY
104577606
Practice Location Phone/Fax
| Phone: | 3476011241 |
| Fax: | 7189602055 |
Provider Mailing Location
1650 GRAND CONCOURSE
BRONX
NY
104577606
Provider Mailing Phone/Fax
| Phone: | 3476011241 |
| Fax: | 7189602055 |