Healthcare Provider Details

I. General information

NPI: 1184610370
Provider Name (Legal Business Name): HERBERT I. PASTERNAK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 VETERANS BLVD
MASSAPEQUA NY
11758-4982
US

IV. Provider business mailing address

854 BRIAR PL
WOODMERE NY
11598-2420
US

V. Phone/Fax

Practice location:
  • Phone: 516-795-5523
  • Fax: 516-795-5521
Mailing address:
  • Phone: 516-569-8487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number151369-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: