Provider Demographics
NPI:1518159524
Name:PASTERNAK, DONNA JEAN (RPA)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JEAN
Last Name:PASTERNAK
Suffix:
Gender:F
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 CENTER CIR
Mailing Address - Street 2:
Mailing Address - City:WASSAIC
Mailing Address - State:NY
Mailing Address - Zip Code:12592-2637
Mailing Address - Country:US
Mailing Address - Phone:845-877-6821
Mailing Address - Fax:845-877-9442
Practice Address - Street 1:26 CENTER CIR
Practice Address - Street 2:
Practice Address - City:WASSAIC
Practice Address - State:NY
Practice Address - Zip Code:12592-2637
Practice Address - Country:US
Practice Address - Phone:845-877-6821
Practice Address - Fax:845-877-9442
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001248-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical