Basic Information
Provider Information
NPI: 1316101447
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PACI
FirstName: JAMES
MiddleName: MICHAEL
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1728 SUNRISE HWY
Address2:  
City: MERRICK
State: NY
PostalCode: 115663745
CountryCode: US
TelephoneNumber: 5162346804
FaxNumber: 5169924637
Practice Location
Address1: 45 CROSSWAYS PARK DR W
Address2:  
City: WOODBURY
State: NY
PostalCode: 117972002
CountryCode: US
TelephoneNumber: 5165362800
FaxNumber: 5169924637
Other Information
ProviderEnumerationDate: 07/17/2008
LastUpdateDate: 03/20/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207XX0005X257800NYY Allopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine

No ID Information.


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