Provider Demographics
NPI:1033292503
Name:PASSAS, PAVLOS S (DC)
Entity Type:Individual
Prefix:DR
First Name:PAVLOS
Middle Name:S
Last Name:PASSAS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 TIMBER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4144
Mailing Address - Country:US
Mailing Address - Phone:516-639-9446
Mailing Address - Fax:631-598-7479
Practice Address - Street 1:99 TIMBER RIDGE DR
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4144
Practice Address - Country:US
Practice Address - Phone:516-639-9446
Practice Address - Fax:631-598-7479
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX10138111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX4G951Medicare ID - Type Unspecified