Provider Demographics
NPI:1194010579
Name:POMMIER, MAX RICARDO JR (DO)
Entity Type:Individual
Prefix:DR
First Name:MAX
Middle Name:RICARDO
Last Name:POMMIER
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:547 WAGSTAFF DR
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-5420
Mailing Address - Country:US
Mailing Address - Phone:516-491-8575
Mailing Address - Fax:
Practice Address - Street 1:340 HOWELLS RD STE A
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-5322
Practice Address - Country:US
Practice Address - Phone:631-666-2864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275020207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology