Provider Demographics
NPI:1598926446
Name:PASTERNAK, ROEY (ROEY PASTERNAK)
Entity Type:Individual
Prefix:
First Name:ROEY
Middle Name:
Last Name:PASTERNAK
Suffix:
Gender:M
Credentials:ROEY PASTERNAK
Other - Prefix:
Other - First Name:ROEY
Other - Middle Name:
Other - Last Name:PASTERNAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:353 E 17TH ST APT 19C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3835
Mailing Address - Country:US
Mailing Address - Phone:917-587-9715
Mailing Address - Fax:
Practice Address - Street 1:353 E 17TH ST APT 19C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3835
Practice Address - Country:US
Practice Address - Phone:917-587-9715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2596312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry