Provider Demographics
NPI:1952787681
Name:PAMOLARCO, ANNABEL (SEIT PROVIDER)
Entity Type:Individual
Prefix:
First Name:ANNABEL
Middle Name:
Last Name:PAMOLARCO
Suffix:
Gender:F
Credentials:SEIT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10423 ROCKAWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-2234
Mailing Address - Country:US
Mailing Address - Phone:347-551-8618
Mailing Address - Fax:
Practice Address - Street 1:10423 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-2234
Practice Address - Country:US
Practice Address - Phone:347-551-8618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY789149131390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program