Healthcare Provider Details

I. General information

NPI: 1366754517
Provider Name (Legal Business Name): KEITH PHILIP PASICHOW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2010
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 E 42ND ST FL 5
NEW YORK NY
10017-5821
US

IV. Provider business mailing address

220 E 42ND ST FL 5
NEW YORK NY
10017-5821
US

V. Phone/Fax

Practice location:
  • Phone: 800-675-0391
  • Fax:
Mailing address:
  • Phone:
  • Fax: 888-487-1131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number262283
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number262283
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number262283
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number262283
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: