Provider Demographics
NPI:1730484122
Name:PANTALEON, MABEL (LPN)
Entity Type:Individual
Prefix:
First Name:MABEL
Middle Name:
Last Name:PANTALEON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 W 157TH ST
Mailing Address - Street 2:APT #100
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-7617
Mailing Address - Country:US
Mailing Address - Phone:310-691-4241
Mailing Address - Fax:
Practice Address - Street 1:550 W 157TH ST
Practice Address - Street 2:APT #100
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-7617
Practice Address - Country:US
Practice Address - Phone:310-691-4241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-17
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY280298-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse