Provider Demographics
NPI:1144254673
Name:PASTERNACK, FRED L
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:L
Last Name:PASTERNACK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:FRED
Other - Middle Name:L
Other - Last Name:PASTERNACK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:29-A EAST 63RD ST.
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-7315
Mailing Address - Country:US
Mailing Address - Phone:212-888-7723
Mailing Address - Fax:
Practice Address - Street 1:29 E 63RD ST
Practice Address - Street 2:A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-7315
Practice Address - Country:US
Practice Address - Phone:212-888-7723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130368207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB12762Medicare UPIN