Provider Demographics
NPI:1861431017
Name:PASTERNACK, STEFAN ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:STEFAN
Middle Name:ALAN
Last Name:PASTERNACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6924 BALBOA ISLAND CT
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-5641
Mailing Address - Country:US
Mailing Address - Phone:561-495-0266
Mailing Address - Fax:561-495-0544
Practice Address - Street 1:950 PENINSULA CORPORATE CIR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1378
Practice Address - Country:US
Practice Address - Phone:561-706-9584
Practice Address - Fax:561-495-0544
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME814452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16167OtherBLUE CROSS NUMBER
FLU4533Medicare ID - Type UnspecifiedFIRST COAST SERVICES NUMB
FL16167OtherBLUE CROSS NUMBER