Provider Demographics
NPI:1326250994
Name:PACITA C. SY, M.D., LLC
Entity Type:Organization
Organization Name:PACITA C. SY, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PACITA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-458-4045
Mailing Address - Street 1:196 JACK MARTIN BLVD
Mailing Address - Street 2:OCEAN MEDICAL PARK, BLDG A-2
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7769
Mailing Address - Country:US
Mailing Address - Phone:732-458-4045
Mailing Address - Fax:732-458-4979
Practice Address - Street 1:196 JACK MARTIN BLVD
Practice Address - Street 2:OCEAN MEDICAL PARK, BLDG A-2
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7769
Practice Address - Country:US
Practice Address - Phone:732-458-4045
Practice Address - Fax:732-458-4979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA63106207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ643213Medicare ID - Type Unspecified
NJG42851Medicare UPIN