Provider Demographics
NPI:1013062652
Name:BAMBARA, PAUL (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:BAMBARA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 STRAWTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1847
Mailing Address - Country:US
Mailing Address - Phone:845-358-7119
Mailing Address - Fax:
Practice Address - Street 1:2 STRAWTOWN RD
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-1847
Practice Address - Country:US
Practice Address - Phone:845-358-7119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX2904111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX2904OtherLICENSE #
NYX16331Medicare ID - Type Unspecified