Provider Demographics
NPI:1669651600
Name:PAMAONG, JERIL MARIE MILLAN (RPT)
Entity Type:Individual
Prefix:MISS
First Name:JERIL MARIE
Middle Name:MILLAN
Last Name:PAMAONG
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3617 PARSONS BLVD
Mailing Address - Street 2:DR WILLIAM BENENSON PAVILION
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5931
Mailing Address - Country:US
Mailing Address - Phone:347-653-1391
Mailing Address - Fax:
Practice Address - Street 1:3290 N RIDGE RD
Practice Address - Street 2:SUITE 290 EXECUTIVE CENTER II CAMBRIDGE HEALTHCARE
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3655
Practice Address - Country:US
Practice Address - Phone:410-750-9006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028749225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist