MEDICARE: DR. JAIME A PABILONIA M.D.

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	2084P0800X	Psychiatry Physician	140075	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700953999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAIME A PABILONIA M.D.

Provider Business Mailing Address
First Line	:	3771 RIVER RD
Second Line	:
City	:	YOUNGSTOWN
State	:	NY
Zip	:	14174-9701
Country	:	US
Telephone Number	:	716-745-3043
Fax Number	:

Provider Business Practice Location Address
First Line	:	3771 RIVER RD
Second Line	:
City	:	YOUNGSTOWN
State	:	NY
Zip	:	14174-9701
Country	:	US
Telephone Number	:	716-745-3043
Fax Number	:

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

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	12/01/2008

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