Provider Demographics
NPI:1861474256
Name:SY, PACITA C (MD)
Entity Type:Individual
Prefix:
First Name:PACITA
Middle Name:C
Last Name:SY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:196 JACK MARTIN BLVD
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7769
Mailing Address - Country:US
Mailing Address - Phone:732-458-4045
Mailing Address - Fax:732-458-4979
Practice Address - Street 1:196 JACK MARTIN BLVD
Practice Address - Street 2:SUITE A-2
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7769
Practice Address - Country:US
Practice Address - Phone:732-458-4045
Practice Address - Fax:732-458-4979
Is Sole Proprietor?:No
Enumeration Date:2005-11-19
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA63106207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ643213Medicare ID - Type Unspecified