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NPI Code Detail

MEDICARE: MS. MARY PACHES

MEDICARE: MS. MARY PACHES
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
1174400000XSpecialist66-007998NY

General Provider Information

NPI Number : 1992132039
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY PACHES
Provider Business Mailing Address
First Line : 3244 31ST STREET
Second Line :
City : ASTORIA
State : NY
Zip : 11106
Country : US
Telephone Number : 718-626-2699
Fax Number :
Provider Business Practice Location Address
First Line : 3244 31ST ST
Second Line :
City : ASTORIA
State : NY
Zip : 11106-2561
Country : US
Telephone Number : 718-626-2699
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2013
Last Update Date : 10/03/2013

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