1528082971 NPI number — PANAMERICAN MEDICAL SERVICES P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528082971 NPI number — PANAMERICAN MEDICAL SERVICES P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PANAMERICAN MEDICAL SERVICES P.C.
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:
Provider Other Organization Name Type Code:
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:
1528082971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8915 175TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAMAICA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11432-5533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-385-9180
Provider Business Mailing Address Fax Number:
718-385-9477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9511 99TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OZONE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11416-2515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-385-9180
Provider Business Practice Location Address Fax Number:
718-385-9477
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MONTENEGRO
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
AUGUSTO
Authorized Official Title or Position:
GENERAL DIRECTOR
Authorized Official Telephone Number:
718-385-9180

Provider Taxonomy Codes

  • Taxonomy code: 170100000X , with the licence number:  227588 , 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)





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