Provider Demographics
NPI:1770685562
Name:BOMBINO, PASQUALE A (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:PASQUALE
Middle Name:A
Last Name:BOMBINO
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1258
Mailing Address - Country:US
Mailing Address - Phone:718-627-2060
Mailing Address - Fax:718-627-1951
Practice Address - Street 1:1670 E 17TH ST
Practice Address - Street 2:2A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1258
Practice Address - Country:US
Practice Address - Phone:718-627-2060
Practice Address - Fax:718-627-1951
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140000011010235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist