Provider Demographics
NPI:1659626331
Name:PASTERNAK, ILANA T (MSED)
Entity Type:Individual
Prefix:
First Name:ILANA
Middle Name:T
Last Name:PASTERNAK
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 KINGS HWY
Mailing Address - Street 2:2J
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1671
Mailing Address - Country:US
Mailing Address - Phone:718-564-0175
Mailing Address - Fax:718-407-2648
Practice Address - Street 1:3321 AVENUE M
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-5421
Practice Address - Country:US
Practice Address - Phone:718-531-1800
Practice Address - Fax:718-407-2648
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist