Provider Demographics
NPI:1952379992
Name:PABICON, VISITACION (MD)
Entity type:Individual
Prefix:
First Name:VISITACION
Middle Name:
Last Name:PABICON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EDGEWATER ST
Mailing Address - Street 2:6TH FL. PAYER RELATIONS
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4900
Mailing Address - Country:US
Mailing Address - Phone:718-226-1008
Mailing Address - Fax:718-226-1039
Practice Address - Street 1:1 EDGEWATER PLAZA
Practice Address - Street 2:1ST FL. LAB
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305
Practice Address - Country:US
Practice Address - Phone:718-226-4130
Practice Address - Fax:718-226-4185
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221683174400000X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00017882OtherRAILROAD MEDICARE
NYP00834565OtherRAILROAD MEDICARE # GRP. DN0541
NYP00834565OtherRAILROAD MEDICARE # GRP. DN0541
G99139Medicare UPIN
NY53B631Medicare PIN