MEDICARE: PAMELA JEAN VANGELAS

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	225X00000X	Occupational Therapist	022632	NY

General Provider Information

NPI Number	:	1891272290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA JEAN VANGELAS

Provider Business Mailing Address
First Line	:	223 HANCOCK AVE UNIT 3
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07307-1916
Country	:	US
Telephone Number	:	201-838-8800
Fax Number	:

Provider Business Practice Location Address
First Line	:	223 HANCOCK AVE UNIT 3
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07307-1916
Country	:	US
Telephone Number	:	201-838-8800
Fax Number	:

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

Provider Enumeration Date	:	07/27/2018
Last Update Date	:	07/27/2018

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Directions to “ PAMELA JEAN VANGELAS ” Practice Location

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