Provider Demographics
NPI:1619953346
Name:PASCUAL, ELSA D (MD)
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:D
Last Name:PASCUAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 ROUTE 207
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-5002
Mailing Address - Country:US
Mailing Address - Phone:845-294-8817
Mailing Address - Fax:845-294-3612
Practice Address - Street 1:3302 ROUTE 207
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-5002
Practice Address - Country:US
Practice Address - Phone:845-294-8817
Practice Address - Fax:845-294-3612
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144835207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY060037984OtherMEDICARE RAIL ROAD
NY00549642Medicaid
NY060037984OtherMEDICARE RAIL ROAD
NY42A271Medicare ID - Type Unspecified