OrganizationPhedre Phara Paulemon(<Unavail>)Nurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address375 Linden Blvd, Brooklyn, NY 11203-2709(917) 907-0797PECOS EnrollmentBased on the most recent information from CMS, provider Phedre Phara Paulemon does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1902542913Provider TypeOrganizationFull NamePhedre Phara PaulemonOther Name<Unavail>SubpartNoEnumeration Date5/11/2022Last Updated5/1/2025Contact InformationPractice LocationPractice Address375 Linden Blvd, Brooklyn, NY 11203-2709Phone(917) 907-0797Fax(917) 933-4212Mailing LocationMailing Address2525 Nostrand Ave Apt 2c, Brooklyn, NY 11210-4715Phone(917) 907-0797Fax(917) 933-4212Authorized OfficialNamePaulemon, Phedre Phara (Owner)Phone(917) 907-0797Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerIDF343011-C1DDescriptionOtherIssuerHEALTHFIRSTNew YorkID05401478DescriptionMedicaidIssuerUnlistedNew YorkID798935DescriptionOtherIssuerCIGANew YorkID835995DescriptionOtherIssuerANTHEM BC/BSNew YorkIDP0569292DescriptionOtherIssuerELDERPLANNew YorkID241008000231DescriptionOtherIssuerFIDELISNew YorkID3886122DescriptionOtherIssuerAETNANew York