Provider Demographics
NPI:1306033352
Name:NEODOC APMC
Entity type:Organization
Organization Name:NEODOC APMC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PANKAJ
Authorized Official - Middle Name:N
Authorized Official - Last Name:MISTRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-482-5478
Mailing Address - Street 1:PO BOX 4838
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-0838
Mailing Address - Country:US
Mailing Address - Phone:626-482-5478
Mailing Address - Fax:626-371-0480
Practice Address - Street 1:1798 NORTH GAREY AVE
Practice Address - Street 2:POMONA VALLEY HOSPITAL MEDICAL CENTER
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767
Practice Address - Country:US
Practice Address - Phone:909-639-7436
Practice Address - Fax:626-371-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0090280OtherMEDI-CAL