MEDICARE: PACITA C. SY, M.D., LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MA63106	NJ

General Provider Information

NPI Number	:	1326250994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACITA C. SY, M.D., LLC

Provider Business Mailing Address
First Line	:	196 JACK MARTIN BLVD
Second Line	:	OCEAN MEDICAL PARK, BLDG A-2
City	:	BRICK
State	:	NJ
Zip	:	08724-7769
Country	:	US
Telephone Number	:	732-458-4045
Fax Number	:	732-458-4979

Provider Business Practice Location Address
First Line	:	196 JACK MARTIN BLVD
Second Line	:	OCEAN MEDICAL PARK, BLDG A-2
City	:	BRICK
State	:	NJ
Zip	:	08724-7769
Country	:	US
Telephone Number	:	732-458-4045
Fax Number	:	732-458-4979

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PACITA C. SY
Credential	:	M.D.
Telephone Number	:	732-458-4045

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	03/11/2008

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