Provider Demographics
NPI:1407845480
Name:PASCH, IAN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:D
Last Name:PASCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 W 35TH ST
Mailing Address - Street 2:16TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-2507
Mailing Address - Country:US
Mailing Address - Phone:212-689-0024
Mailing Address - Fax:212-643-9370
Practice Address - Street 1:224 W 35TH ST
Practice Address - Street 2:16TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2507
Practice Address - Country:US
Practice Address - Phone:212-689-0024
Practice Address - Fax:212-643-9370
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY361961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00715522Medicaid