Individual
VISITACION PABICON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1 EDGEWATER PLAZA, 1ST FL. LAB, STATEN ISLAND, NY 10305
(718) 226-4130
(718) 226-4185
Mailing address
1 EDGEWATER ST, 6TH FL. PAYER RELATIONS, STATEN ISLAND, NY 10305-4900
(718) 226-1008
(718) 226-1039
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
221683
NY
207ZP0101X
Anatomic Pathology Physician
Primary
221683
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00017882
RAILROAD MEDICARE
—
01
—
P00834565
RAILROAD MEDICARE # GRP. DN0541
NY
Enumeration date
03/08/2006
Last updated
08/18/2010
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