Provider Demographics
NPI:1386662211
Name:PAMELA A WEBER MD PC
Entity type:Organization
Organization Name:PAMELA A WEBER MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-924-4300
Mailing Address - Street 1:1500 WILLIAM FLOYD PKWY
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967
Mailing Address - Country:US
Mailing Address - Phone:631-924-4300
Mailing Address - Fax:631-924-2525
Practice Address - Street 1:1500 WILLIAM FLOYD PKWY
Practice Address - Street 2:SUITE 304
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967
Practice Address - Country:US
Practice Address - Phone:631-924-4300
Practice Address - Fax:631-924-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1657721207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01184812Medicaid
NY01184812Medicaid
B98198Medicare UPIN
WFC071Medicare PIN