Healthcare Provider Details

I. General information

NPI: 1508784455
Provider Name (Legal Business Name): ANDRES PACHECO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24008 135TH AVE
ROSEDALE NY
11422-1511
US

IV. Provider business mailing address

18 MAGNOLIA AVE
WEST HAVEN CT
06516-6312
US

V. Phone/Fax

Practice location:
  • Phone: 203-821-1366
  • Fax:
Mailing address:
  • Phone: 203-821-1366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number131881
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: