Healthcare Provider Details

I. General information

NPI: 1477822138
Provider Name (Legal Business Name): PAMBO MEDICAL NEURO-REHABILITATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2011
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 GRAND CONCOURSE SUITE 1J
BRONX NY
10451-2705
US

IV. Provider business mailing address

930 GRAND CONCOURSE SUITE 1J
BRONX NY
10451-2705
US

V. Phone/Fax

Practice location:
  • Phone: 718-410-5000
  • Fax:
Mailing address:
  • Phone: 718-410-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number192310
License Number StateNY

VIII. Authorized Official

Name: OSAFRADU OPAM
Title or Position: PRESIDENT
Credential: MD
Phone: 718-410-5000