Healthcare Provider Details

I. General information

NPI: 1710342092
Provider Name (Legal Business Name): KRISTINE R PASCUMA CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2015
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1991 MARCUS AVE SUITE M 100
NEW HYDE PARK NY
11042-2057
US

IV. Provider business mailing address

1991 MARCUS AVE SUITE M 100
NEW HYDE PARK NY
11042-2057
US

V. Phone/Fax

Practice location:
  • Phone: 516-472-3650
  • Fax:
Mailing address:
  • Phone: 516-472-3650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number630911-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF382568-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: