Provider Demographics
NPI:1205865896
Name:PASTOR, THOMAS J (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:PASTOR
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 1:1561 LONG POND ROAD
Mailing Address - Street 2:SUITE #202
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626
Mailing Address - Country:US
Mailing Address - Phone:585-723-7778
Mailing Address - Fax:585-723-7925
Practice Address - Street 1:1561 LONG POND ROAD
Practice Address - Street 2:SUITE #202
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626
Practice Address - Country:US
Practice Address - Phone:585-723-7778
Practice Address - Fax:585-723-7925
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224673207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02312792Medicaid
NYP01789654OtherMEDICARE RR
NY02312792Medicaid
NYRA0131/ BA0017 GRPMedicare PIN