MEDICARE: MISS JERIL MARIE MILLAN PAMAONG RPT

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	225100000X	Physical Therapist	028749	NY

General Provider Information

NPI Number	:	1669651600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JERIL MARIE MILLAN PAMAONG RPT

Provider Business Mailing Address
First Line	:	3617 PARSONS BLVD
Second Line	:	DR WILLIAM BENENSON PAVILION
City	:	FLUSHING
State	:	NY
Zip	:	11354-5931
Country	:	US
Telephone Number	:	347-653-1391
Fax Number	:

Provider Business Practice Location Address
First Line	:	3290 N RIDGE RD
Second Line	:	SUITE 290 EXECUTIVE CENTER II CAMBRIDGE HEALTHCARE
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-3655
Country	:	US
Telephone Number	:	410-750-9006
Fax Number	:

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

Provider Enumeration Date	:	10/26/2007
Last Update Date	:	10/26/2007

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