Healthcare Provider Details

I. General information

NPI: 1497846737
Provider Name (Legal Business Name): LOURDES MARIA PICHAY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 PARK HILL CT
STATEN ISLAND NY
10304-3613
US

IV. Provider business mailing address

29 PLEASANT PLAINS AVE
STATEN ISLAND NY
10309-2713
US

V. Phone/Fax

Practice location:
  • Phone: 718-876-6925
  • Fax: 718-818-5911
Mailing address:
  • Phone: 718-876-6925
  • Fax: 718-818-5911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number175351
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: