Provider Demographics
NPI:1497946545
Name:PASCHOS CAROLINA BRILATA RN PC
Entity Type:Organization
Organization Name:PASCHOS CAROLINA BRILATA RN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:B
Authorized Official - Last Name:PASCHOS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:718-956-4740
Mailing Address - Street 1:2314 BROADWAY
Mailing Address - Street 2:2F
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4153
Mailing Address - Country:US
Mailing Address - Phone:718-956-4740
Mailing Address - Fax:
Practice Address - Street 1:2314 BROADWAY
Practice Address - Street 2:2F
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-4153
Practice Address - Country:US
Practice Address - Phone:718-956-4740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY489789-1385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01812220Medicaid