Healthcare Provider Details

I. General information

NPI: 1295185569
Provider Name (Legal Business Name): GEORGE PAHALAN PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 HILLSIDE AVE STE 208
NEW HYDE PARK NY
11040-2501
US

IV. Provider business mailing address

1575 HILLSIDE AVE
NEW HYDE PARK NY
11040-2521
US

V. Phone/Fax

Practice location:
  • Phone: 516-888-9394
  • Fax:
Mailing address:
  • Phone: 917-756-5279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number408078
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: