| Chess Medicine Pllc | |
|
7 Hemion Rd Ste 110 Montebello NY 10901-4919 | |
| (203) 666-8145 | |
| (203) 456-9793 |
| Full Name | Chess Medicine Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 7 Hemion Rd Ste 110, Montebello, New York |
| Authorized Official Name and Position | David M Chess (PRESIDENT) |
| Authorized Official Contact | 2036668145 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chess Medicine Pllc 7 Hemion Rd Ste 110 Montebello NY 10901-4919 Ph: (203) 666-8145 | Chess Medicine Pllc 7 Hemion Rd Ste 110 Montebello NY 10901-4919 Ph: (203) 666-8145 |
| NPI Number | 1699385021 |
|---|---|
| Provider Enumeration Date | 07/31/2020 |
| Last Update Date | 02/05/2024 |
| Certification Date | 02/05/2024 |
| Medicare PECOS PAC ID | 6406260736 |
|---|---|
| Medicare Enrollment ID | O20210128001097 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699385021 | NPI | - | NPPES |
| 05875296 | Medicaid | NY |
| Provider Name | Sally Soyoung Lee |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447221189 PECOS PAC ID: 1557251600 Enrollment ID: I20040319001213 |
| Provider Name | Eileen C Irish |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417165549 PECOS PAC ID: 9931194552 Enrollment ID: I20040414001829 |
| Provider Name | Linda L Luciani |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881636199 PECOS PAC ID: 8123018538 Enrollment ID: I20040517001182 |
| Provider Name | Hongjuan Li |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396812566 PECOS PAC ID: 9032198874 Enrollment ID: I20040715001100 |
| Provider Name | Janice Valencourt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699874537 PECOS PAC ID: 9032155874 Enrollment ID: I20050701000750 |
| Provider Name | Darakhshan F Shamsie |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821033481 PECOS PAC ID: 4981633138 Enrollment ID: I20050808000698 |
| Provider Name | Cheryl Lynn Race |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952358137 PECOS PAC ID: 1052322211 Enrollment ID: I20060601000223 |
| Provider Name | Aleksandra Cobb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558515320 PECOS PAC ID: 9739242462 Enrollment ID: I20090107000220 |
| Provider Name | Nadine Finlayson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144424037 PECOS PAC ID: 0446392666 Enrollment ID: I20100126000222 |
| Provider Name | Bradley A Speta |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689994147 PECOS PAC ID: 6305962770 Enrollment ID: I20100923000635 |
| Provider Name | Kachi N Nweke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245462084 PECOS PAC ID: 5991831265 Enrollment ID: I20101210000026 |
| Provider Name | Catherine A Roberts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619050713 PECOS PAC ID: 2567650815 Enrollment ID: I20101230000540 |
| Provider Name | David T Ouyang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417937780 PECOS PAC ID: 5597722421 Enrollment ID: I20110125000078 |
| Provider Name | Jialin S Nah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336334457 PECOS PAC ID: 8921283672 Enrollment ID: I20110425000304 |
| Provider Name | Virginia Clive |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801083043 PECOS PAC ID: 3779768247 Enrollment ID: I20110427000117 |
| Provider Name | Paul Maggio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174857403 PECOS PAC ID: 7810165073 Enrollment ID: I20131007001559 |
| Provider Name | Merin S Joseph |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083032882 PECOS PAC ID: 5698999852 Enrollment ID: I20140610001695 |
| Provider Name | Tamari N Turnbull-lewis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689927238 PECOS PAC ID: 6406171560 Enrollment ID: I20150212000104 |
| Provider Name | Emelia Asare |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891191987 PECOS PAC ID: 8325363005 Enrollment ID: I20150223000214 |
| Provider Name | Sarah Onyenwe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184986176 PECOS PAC ID: 4486963170 Enrollment ID: I20151020001686 |
| Provider Name | Yasmin Bahar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790161529 PECOS PAC ID: 2163722083 Enrollment ID: I20151130000007 |
| Provider Name | Shaneeza Obrian |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588972145 PECOS PAC ID: 1052600665 Enrollment ID: I20160523000069 |
| Provider Name | Mary Jill Vaillancourt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104290915 PECOS PAC ID: 0244531747 Enrollment ID: I20160819002082 |
| Provider Name | Camelia L Evans |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891170122 PECOS PAC ID: 3870875057 Enrollment ID: I20170124000527 |
| Provider Name | Simone Watson-walke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952855744 PECOS PAC ID: 9638452451 Enrollment ID: I20170201001756 |
| Provider Name | Louis Demarco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174946099 PECOS PAC ID: 2264703099 Enrollment ID: I20170811002255 |
| Provider Name | Genevieve Romano-helm |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578990461 PECOS PAC ID: 1052683216 Enrollment ID: I20170823000594 |
| Provider Name | Justin D Loomis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043763576 PECOS PAC ID: 8022385327 Enrollment ID: I20171010003048 |
| Provider Name | Jennifer L Wester |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689907883 PECOS PAC ID: 3678830353 Enrollment ID: I20171205002539 |
| Provider Name | Irina Zavulunova |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134423478 PECOS PAC ID: 9032439229 Enrollment ID: I20171211001416 |
| Provider Name | Maranda Mccray-dixon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154595304 PECOS PAC ID: 1254501992 Enrollment ID: I20180329001904 |
| Provider Name | Natalya Coles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801317623 PECOS PAC ID: 4486917036 Enrollment ID: I20180412000123 |
| Provider Name | Jacqueline S Mahabir |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609388123 PECOS PAC ID: 3072878289 Enrollment ID: I20180517000701 |
| Provider Name | Valentyna Oleksyuk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780163790 PECOS PAC ID: 5092068494 Enrollment ID: I20181101002176 |
| Provider Name | Dalu Q Lewis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043749955 PECOS PAC ID: 3173898194 Enrollment ID: I20181206001549 |
| Provider Name | Kellyann P Civiletti |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770034373 PECOS PAC ID: 3870859085 Enrollment ID: I20181218000588 |
| Provider Name | Thelma Monterroso |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265786545 PECOS PAC ID: 5193950418 Enrollment ID: I20190102000788 |
| Provider Name | Muriel S Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003113630 PECOS PAC ID: 9234374927 Enrollment ID: I20190524000067 |
| Provider Name | Shawna Davidson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225432420 PECOS PAC ID: 2668791914 Enrollment ID: I20190614002334 |
| Provider Name | Tiffany N Nicholson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093054975 PECOS PAC ID: 8729318837 Enrollment ID: I20191002001482 |
| Provider Name | Jelana Sade Grissom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750931739 PECOS PAC ID: 9537591698 Enrollment ID: I20191112002289 |
| Provider Name | Eric Paolilli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326521741 PECOS PAC ID: 9638503246 Enrollment ID: I20200107000236 |
| Provider Name | David Mark Chess |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1376521773 PECOS PAC ID: 0749175404 Enrollment ID: I20200218002310 |
| Provider Name | Sheri Ann Armstrong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497236848 PECOS PAC ID: 1052748217 Enrollment ID: I20200227001951 |
| Provider Name | Babette Burgan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720210362 PECOS PAC ID: 1153758149 Enrollment ID: I20200304001466 |
| Provider Name | Mohammadreza Feizi Lighvan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699392894 PECOS PAC ID: 3678985587 Enrollment ID: I20201217003008 |
| Provider Name | Michelle N Reynolds |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356574982 PECOS PAC ID: 2466728589 Enrollment ID: I20210130000097 |
| Provider Name | Claudia Walker-lewis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326686676 PECOS PAC ID: 1557772126 Enrollment ID: I20210304001394 |
| Provider Name | Ashley Bullard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144521402 PECOS PAC ID: 0345656906 Enrollment ID: I20210304002360 |
| Provider Name | Frances Ann Lambiase |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154907533 PECOS PAC ID: 4385052539 Enrollment ID: I20210428000631 |
| Provider Name | Kate Cordisco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003246851 PECOS PAC ID: 0345467247 Enrollment ID: I20210609000773 |
| Provider Name | Franckel Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992254395 PECOS PAC ID: 9537428578 Enrollment ID: I20210630003016 |
| Provider Name | Sheikh Islam |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407301898 PECOS PAC ID: 0840529301 Enrollment ID: I20210701002476 |
| Provider Name | Wesley Wendell Lynch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568868404 PECOS PAC ID: 4789903931 Enrollment ID: I20210716000218 |
| Provider Name | Bobby Malik |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396804712 PECOS PAC ID: 7416972690 Enrollment ID: I20210809003413 |
| Provider Name | Sakirudeen Olusesi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760006522 PECOS PAC ID: 8022423797 Enrollment ID: I20211005003532 |
| Provider Name | Amanda Ramos-rubalcava |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326680323 PECOS PAC ID: 3274965652 Enrollment ID: I20211008002831 |
| Provider Name | Thomas Votto |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487037628 PECOS PAC ID: 3476944364 Enrollment ID: I20220104001217 |
| Provider Name | Kelli Mayfield |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598743114 PECOS PAC ID: 5698746311 Enrollment ID: I20220110002422 |
| Provider Name | Kristen Canzler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124781877 PECOS PAC ID: 2668865650 Enrollment ID: I20220216000652 |
| Provider Name | Patricia Ann Angelucci |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134465636 PECOS PAC ID: 8729184650 Enrollment ID: I20220307000889 |
| Provider Name | Nicole Marie Simone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285046284 PECOS PAC ID: 2769600139 Enrollment ID: I20220615002550 |
| Provider Name | Tyesha Hardwick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639481054 PECOS PAC ID: 8628451556 Enrollment ID: I20220810001511 |
| Provider Name | Anna Morin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770559445 PECOS PAC ID: 5193624054 Enrollment ID: I20220826002996 |
| Provider Name | Vanessa Wejuli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811490733 PECOS PAC ID: 7517341209 Enrollment ID: I20220830000590 |
| Provider Name | Sylvia C Terry Ucheagwu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689347031 PECOS PAC ID: 8921483447 Enrollment ID: I20220920002894 |
| Provider Name | Erin K Springer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912635418 PECOS PAC ID: 2961888441 Enrollment ID: I20221006002371 |
| Provider Name | Rita A Dompreh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417162231 PECOS PAC ID: 7113189937 Enrollment ID: I20221202001805 |
| Provider Name | Dominique Pinilla |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124103965 PECOS PAC ID: 4880604446 Enrollment ID: I20221220000320 |
| Provider Name | Phyllis M Stapleton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740947852 PECOS PAC ID: 5597149542 Enrollment ID: I20221229002457 |
| Provider Name | Lee-anne J Millas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558766139 PECOS PAC ID: 7618290016 Enrollment ID: I20230103001989 |
| Provider Name | Mary Elizabeth Malen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386784676 PECOS PAC ID: 2567516057 Enrollment ID: I20230109001437 |
| Provider Name | Ianina Metcalf |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447899091 PECOS PAC ID: 7719374644 Enrollment ID: I20230124002773 |
| Provider Name | Fern M. Harris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356838163 PECOS PAC ID: 8022489103 Enrollment ID: I20230127002013 |
| Provider Name | Carissa Kelly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821307646 PECOS PAC ID: 2264627132 Enrollment ID: I20230215002097 |
| Provider Name | Bridgett Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629580519 PECOS PAC ID: 3375931702 Enrollment ID: I20230216001773 |
| Provider Name | Dana M Hill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699248260 PECOS PAC ID: 3971836529 Enrollment ID: I20230421002124 |
| Provider Name | Regina B Glisson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245576834 PECOS PAC ID: 7214175256 Enrollment ID: I20230421002194 |
| Provider Name | Ramon Trinidad |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588211627 PECOS PAC ID: 2860829355 Enrollment ID: I20230515001148 |
| Provider Name | Malinda Aqueelah Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982114625 PECOS PAC ID: 5092062828 Enrollment ID: I20230629001472 |
| Provider Name | Regina Geraci |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730792730 PECOS PAC ID: 9133588783 Enrollment ID: I20230629003573 |
| Provider Name | Linda Igbinoba |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376010314 PECOS PAC ID: 0749610665 Enrollment ID: I20230703002504 |
| Provider Name | Kristin Rainelle Curcio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538195276 PECOS PAC ID: 9234174343 Enrollment ID: I20230718004051 |
| Provider Name | Elena Krivulin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396436150 PECOS PAC ID: 0345609608 Enrollment ID: I20230730000141 |
| Provider Name | Cassondra Hawkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750916433 PECOS PAC ID: 7315355211 Enrollment ID: I20230810000194 |
| Provider Name | Jessica Fichter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447643986 PECOS PAC ID: 5698087732 Enrollment ID: I20230905001342 |
| Provider Name | Vera Castellano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831849314 PECOS PAC ID: 7315320918 Enrollment ID: I20230914001417 |
| Provider Name | Carolyn R Blackman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396881546 PECOS PAC ID: 4587632997 Enrollment ID: I20231012003212 |
| Provider Name | David Dinello |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174693170 PECOS PAC ID: 2668529116 Enrollment ID: I20231016001277 |
| Provider Name | Olayemi Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003503103 PECOS PAC ID: 4880040955 Enrollment ID: I20231025002482 |
| Provider Name | Jessica Suzanne Hicks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821675158 PECOS PAC ID: 5395145593 Enrollment ID: I20240329002017 |
| Provider Name | Melissa Davey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891129482 PECOS PAC ID: 3072855253 Enrollment ID: I20240417001559 |
| Provider Name | Denise Ace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003572033 PECOS PAC ID: 6901295450 Enrollment ID: I20240711002451 |
| Provider Name | Andrietta Wright Barnett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043648140 PECOS PAC ID: 4385875673 Enrollment ID: I20241007002079 |
| Provider Name | Pawanjot Samra |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437882560 PECOS PAC ID: 6305290438 Enrollment ID: I20250603000829 |