Provider Demographics
NPI:1083790828
Name:BANKS, PAMELA (DO)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 HEWLETT AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3932
Mailing Address - Country:US
Mailing Address - Phone:516-379-4900
Mailing Address - Fax:516-379-4276
Practice Address - Street 1:150 HEWLETT AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3932
Practice Address - Country:US
Practice Address - Phone:516-379-4900
Practice Address - Fax:516-379-4276
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1869872080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY186987OtherNYS LICENSE
NYBB2935851OtherDEA
NYF53612Medicare UPIN