MEDICARE: MATTHEW ROMAN PABIS M.D.

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	207Q00000X	Family Medicine Physician	285645	NY

General Provider Information

NPI Number	:	1376981589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW ROMAN PABIS M.D.

Provider Business Mailing Address
First Line	:	201 E 69TH ST
Second Line	:	STE 2C
City	:	NEW YORK
State	:	NY
Zip	:	10021-5465
Country	:	US
Telephone Number	:	212-982-3470
Fax Number	:

Provider Business Practice Location Address
First Line	:	57 ST MARK'S PLACE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-4318
Country	:	US
Telephone Number	:	212-982-3470
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2013
Last Update Date	:	01/09/2018

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