1790959674 NPI number — PAMEL VISION AND LASER GROUP

Table of content: (NPI 1790959674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790959674 NPI number — PAMEL VISION AND LASER GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAMEL VISION AND LASER GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GREGORY J PAMEL M.D., P.C.
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790959674
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 E 61ST ST
Provider Second Line Business Mailing Address:
SUITE 1B
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10065-8183
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-355-2215
Provider Business Mailing Address Fax Number:
212-355-6930

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2308 30TH AVE
Provider Second Line Business Practice Location Address:
5TH FLOOR
Provider Business Practice Location Address City Name:
ASTORIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11102-3397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-278-3800
Provider Business Practice Location Address Fax Number:
718-278-3318
Provider Enumeration Date:
04/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PAMEL
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
212-355-2215

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  194606 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01465567 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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