Provider Demographics
NPI:1508951740
Name:PAKISH, TERRY A (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:A
Last Name:PAKISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:A
Other - Last Name:PAKISH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1901 NORTH OLDEN AVE EXT
Mailing Address - Street 2:SUITE 9A
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618
Mailing Address - Country:US
Mailing Address - Phone:609-883-3444
Mailing Address - Fax:609-883-6297
Practice Address - Street 1:1901 NORTH OLDEN AVE EXT
Practice Address - Street 2:SUITE 9A
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618
Practice Address - Country:US
Practice Address - Phone:609-883-3444
Practice Address - Fax:609-883-6297
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2009-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA40233208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0270857001OtherAMERIHEALTH
E08727OtherAMERIHEALTH ADMINISTRATOR
NJ223649732OtherHORIZON BLUE CROSS AND BL
208136OtherUNITED HEALTHCARE PIN
1K3854OtherHEALTH NET OF NORTHEAST
223649732OtherAETNA
223649732OtherCIGNA
4316089OtherAETNA PIN
PA508727OtherBLUE CROSS AND BLUE SHIEL
P2943261OtherOXFORD HEALTH PLAN
223649732OtherUNITED HEALTHCARE
53172OtherHIGHMARK BLUE CROSS BLUE
223649732OtherUNITED HEALTHCARE
E08727OtherAMERIHEALTH ADMINISTRATOR
53172OtherHIGHMARK BLUE CROSS BLUE