Provider Demographics
NPI:1497846737
Name:PICHAY, LOURDES MARIA (MD)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:MARIA
Last Name:PICHAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 PLEASANT PLAINS AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-2713
Mailing Address - Country:US
Mailing Address - Phone:718-876-6925
Mailing Address - Fax:718-818-5911
Practice Address - Street 1:11 PARK HILL CT
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-3613
Practice Address - Country:US
Practice Address - Phone:718-876-6925
Practice Address - Fax:718-818-5911
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175351208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01134647Medicaid
NYD93285Medicare UPIN