Provider Demographics
NPI:1881897940
Name:JAMES PACHOLKA-MORAN, MD PC
Entity type:Organization
Organization Name:JAMES PACHOLKA-MORAN, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:PACHOLKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-612-7956
Mailing Address - Street 1:314 W 14TH ST
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-5002
Mailing Address - Country:US
Mailing Address - Phone:212-366-1548
Mailing Address - Fax:800-735-4539
Practice Address - Street 1:314 W 14TH ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-5002
Practice Address - Country:US
Practice Address - Phone:212-366-1548
Practice Address - Fax:800-735-4539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174644208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01344687Medicaid
NY56K112Medicare ID - Type Unspecified
NY01344687Medicaid
NYA100000741Medicare PIN