MEDICARE: PAMBO MEDICAL NEURO-REHABILITATION PC

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	2084N0008X	Neuromuscular Medicine (Psychiatry & Neurology) Physician	192310	NY

General Provider Information

NPI Number	:	1477822138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAMBO MEDICAL NEURO-REHABILITATION PC

Provider Business Mailing Address
First Line	:	930 GRAND CONCOURSE
Second Line	:	SUITE 1J
City	:	BRONX
State	:	NY
Zip	:	10451-2705
Country	:	US
Telephone Number	:	718-410-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	930 GRAND CONCOURSE
Second Line	:	SUITE 1J
City	:	BRONX
State	:	NY
Zip	:	10451-2705
Country	:	US
Telephone Number	:	718-410-5000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	OSAFRADU OPAM
Credential	:	MD
Telephone Number	:	718-410-5000

Provider Enumeration Date	:	12/23/2011
Last Update Date	:	11/30/2016

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