Provider Demographics
NPI:1790959674
Name:PAMEL VISION AND LASER GROUP
Entity Type:Organization
Organization Name:PAMEL VISION AND LASER GROUP
Other - Org Name:GREGORY J PAMEL M.D., P.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAMEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:212-355-2215
Mailing Address - Street 1:115 E 61ST ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8183
Mailing Address - Country:US
Mailing Address - Phone:212-355-2215
Mailing Address - Fax:212-355-6930
Practice Address - Street 1:2308 30TH AVE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3397
Practice Address - Country:US
Practice Address - Phone:718-278-3800
Practice Address - Fax:718-278-3318
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAMEL VISION AND LASER GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-22
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194606174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01465567Medicaid
06213Medicare PIN
NY01465567Medicaid