Provider Demographics
NPI:1417902115
Name:PACIS, ANDRESITO B (MD)
Entity Type:Individual
Prefix:
First Name:ANDRESITO
Middle Name:B
Last Name:PACIS
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:441 9TH AVE
Mailing Address - Street 2:CREDENTIALING 3RD FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-1623
Mailing Address - Country:US
Mailing Address - Phone:646-680-2894
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:8615 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4427
Practice Address - Country:US
Practice Address - Phone:718-899-6600
Practice Address - Fax:718-397-7782
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2015-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1252132085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00234428Medicaid
NY9255NVMedicare PIN
NYC08546Medicare UPIN