Healthcare Provider Details

I. General information

NPI: 1760540058
Provider Name (Legal Business Name): PETER J PASQUA JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10031 4TH AVE SUITE 1E
BKLYN NY
11209
US

IV. Provider business mailing address

10031 4TH AVE SUITE 1E
BKLYN NY
11209
US

V. Phone/Fax

Practice location:
  • Phone: 718-748-8660
  • Fax: 718-921-9136
Mailing address:
  • Phone: 718-748-8660
  • Fax: 718-921-9136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number148388
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: