Healthcare Provider Details

I. General information

NPI: 1114339645
Provider Name (Legal Business Name): PAMELA MISHAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAMELA S. PHILIPPSBORN NP

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 E 102ND ST FL 5
NEW YORK NY
10029-6030
US

IV. Provider business mailing address

345 E 80TH ST APT 9F
NEW YORK NY
10075-0682
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-5656
  • Fax: 646-537-9540
Mailing address:
  • Phone: 908-337-3718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number306887
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00502000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: