Provider Demographics
NPI:1477822138
Name:PAMBO MEDICAL NEURO-REHABILITATION PC
Entity Type:Organization
Organization Name:PAMBO MEDICAL NEURO-REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OSAFRADU
Authorized Official - Middle Name:
Authorized Official - Last Name:OPAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-410-5000
Mailing Address - Street 1:930 GRAND CONCOURSE
Mailing Address - Street 2:SUITE 1J
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-2705
Mailing Address - Country:US
Mailing Address - Phone:718-410-5000
Mailing Address - Fax:
Practice Address - Street 1:930 GRAND CONCOURSE
Practice Address - Street 2:SUITE 1J
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-2705
Practice Address - Country:US
Practice Address - Phone:718-410-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-23
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1923102084N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular MedicineGroup - Single Specialty