Healthcare Provider Details

I. General information

NPI: 1801250485
Provider Name (Legal Business Name): JORDAN B PASTERNACK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 GREENWICH OFFICE PARK
GREENWICH CT
06831-5151
US

IV. Provider business mailing address

4802 10TH AVE MAIMONIDES MEDICAL CENTER
BROOKLYN NY
11219-2916
US

V. Phone/Fax

Practice location:
  • Phone: 203-869-1145
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number73250
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: