Provider Demographics
NPI:1679390967
Name:FRED L. PASTERNACK, M.D.
Entity type:Organization
Organization Name:FRED L. PASTERNACK, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:PASTERNACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-735-3790
Mailing Address - Street 1:276 CHESHIRE TPKE
Mailing Address - Street 2:
Mailing Address - City:LANGDON
Mailing Address - State:NH
Mailing Address - Zip Code:03602-8608
Mailing Address - Country:US
Mailing Address - Phone:347-735-3790
Mailing Address - Fax:
Practice Address - Street 1:276 CHESHIRE TPKE
Practice Address - Street 2:
Practice Address - City:LANGDON
Practice Address - State:NH
Practice Address - Zip Code:03602-8608
Practice Address - Country:US
Practice Address - Phone:347-735-3790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service