Provider Demographics
NPI:1619421518
Name:PACHOWSKA, JUSTYNA (PA-C)
Entity Type:Individual
Prefix:
First Name:JUSTYNA
Middle Name:
Last Name:PACHOWSKA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23687
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-3687
Mailing Address - Country:US
Mailing Address - Phone:860-777-0170
Mailing Address - Fax:919-666-6456
Practice Address - Street 1:40 DALE RD STE 100
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3692
Practice Address - Country:US
Practice Address - Phone:860-322-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020333363A00000X
CT003636363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant