Provider Demographics
NPI:1700953999
Name:PABILONIA, JAIME A (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:A
Last Name:PABILONIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3771 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14174-9701
Mailing Address - Country:US
Mailing Address - Phone:716-745-3043
Mailing Address - Fax:
Practice Address - Street 1:3771 RIVER RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:NY
Practice Address - Zip Code:14174-9701
Practice Address - Country:US
Practice Address - Phone:716-745-3043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1400752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00635387Medicaid
NY00675796Medicaid
NY00675796Medicaid
NYB71612Medicare UPIN