Healthcare Provider Details

I. General information

NPI: 1518919661
Provider Name (Legal Business Name): PAMELA KAW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 12/26/2021
Certification Date: 12/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 STARBUCK DR STE 208
GREEN ISLAND NY
12183-1280
US

IV. Provider business mailing address

16 WEISHEIT RD
GLENMONT NY
12077-4000
US

V. Phone/Fax

Practice location:
  • Phone: 518-274-3390
  • Fax:
Mailing address:
  • Phone: 518-378-7797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number239161
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: