Provider Demographics
NPI:1225514680
Name:PIONEER MEDICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:PIONEER MEDICAL ASSOCIATES, PLLC
Other - Org Name:--SELECT--
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LATA
Authorized Official - Middle Name:
Authorized Official - Last Name:PABLANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-879-0325
Mailing Address - Street 1:2545 FOREST BREEZE DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-0070
Mailing Address - Country:US
Mailing Address - Phone:718-879-0325
Mailing Address - Fax:
Practice Address - Street 1:14111 KING RD STE 320
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75036-8981
Practice Address - Country:US
Practice Address - Phone:469-888-4890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-18
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1912142985OtherNPI