Provider Demographics
NPI:1952571002
Name:MIRABELLA, PAMELA J (PA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:MIRABELLA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:J
Other - Last Name:KEEFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 9685
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11555-9685
Mailing Address - Country:US
Mailing Address - Phone:212-513-7711
Mailing Address - Fax:212-513-7723
Practice Address - Street 1:19 BEEKMAN ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-1522
Practice Address - Country:US
Practice Address - Phone:212-513-7711
Practice Address - Fax:212-513-7723
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010799363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010799OtherNYS MEDICAL LICENSE