=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023131844
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN WEIGEL PASTERNAK D.M.H.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9 DESBROSSES ST SUITE 406
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10013-1701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-548-2394
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 179 DUANE ST APT 5
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10013-3397
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-219-8384
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 016382
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------