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General NPI Number Information
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NPI Number | 1639380694
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Entity Type | Individual
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Provider Name | MINTA PAMELA SPAIN MD
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Gender | Female
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1400 PELHAM PARKWAY SOUTH NR 3N7
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City | BRONX
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State | NY
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Zip | 10461
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Country | US
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Telephone | 718-918-3886
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Fax | 718-918-7526
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Provider Business Mailing Address
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Address Line | PO BOX 1465
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City | NEW YORK
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State | NY
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Zip | 10159-1465
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Country | US
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Telephone | 718-918-3886
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Fax | 718-918-7526
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 192304
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License Number State | NY
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