MEDICARE: PABLO CARDOSO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	018908-1	NY

General Provider Information

NPI Number	:	1093190001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PABLO CARDOSO

Provider Business Mailing Address
First Line	:	60 W 142ND ST APT 9C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10037-1110
Country	:	US
Telephone Number	:	646-755-1059
Fax Number	:

Provider Business Practice Location Address
First Line	:	71 METROPOLITAN OVAL
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-6402
Country	:	US
Telephone Number	:	718-597-3111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2015
Last Update Date	:	12/14/2015

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Directions to “ PABLO CARDOSO ” Practice Location

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