Provider Demographics
NPI:1295185569
Name:PAHALAN, GEORGE (LPN)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:PAHALAN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13209 109TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-1701
Mailing Address - Country:US
Mailing Address - Phone:917-756-5279
Mailing Address - Fax:
Practice Address - Street 1:13209 109TH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-1701
Practice Address - Country:US
Practice Address - Phone:917-756-5279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY322447164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse