MEDICARE: DR. MAX RICARDO POMMIER JR. D.O.

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	207RN0300X	Nephrology Physician	275020	NY

General Provider Information

NPI Number	:	1194010579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAX RICARDO POMMIER JR. D.O.

Provider Business Mailing Address
First Line	:	547 WAGSTAFF DR
Second Line	:
City	:	EAST MEADOW
State	:	NY
Zip	:	11554-5420
Country	:	US
Telephone Number	:	516-491-8575
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 HOWELLS RD STE A
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-5322
Country	:	US
Telephone Number	:	631-666-2864
Fax Number	:

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

Provider Enumeration Date	:	06/14/2011
Last Update Date	:	03/09/2023

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