Healthcare Provider Details

I. General information

NPI: 1962331777
Provider Name (Legal Business Name): PISHOI BAKOOM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 MCARTHUR AVE
STATEN ISLAND NY
10312-1925
US

IV. Provider business mailing address

26 MCARTHUR AVE
STATEN ISLAND NY
10312-1925
US

V. Phone/Fax

Practice location:
  • Phone: 347-476-7754
  • Fax:
Mailing address:
  • Phone: 347-476-7754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: