Healthcare Provider Details

I. General information

NPI: 1750343588
Provider Name (Legal Business Name): LOUIS T PASTORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 YAPHANK RD STE 11B
EAST PATCHOGUE NY
11772-4800
US

IV. Provider business mailing address

250 YAPHANK RD STE 11B
EAST PATCHOGUE NY
11772-4800
US

V. Phone/Fax

Practice location:
  • Phone: 631-475-5051
  • Fax: 631-475-8268
Mailing address:
  • Phone: 631-475-5051
  • Fax: 631-475-8268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number096604
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: