Provider Demographics
NPI:1821304593
Name:TERRY A. PAKISH M.D., P.C.
Entity Type:Organization
Organization Name:TERRY A. PAKISH M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAKISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-883-3444
Mailing Address - Street 1:1901 N OLDEN AVENUE EXT
Mailing Address - Street 2:STE. 9A
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-2111
Mailing Address - Country:US
Mailing Address - Phone:609-883-3444
Mailing Address - Fax:609-883-6297
Practice Address - Street 1:1901 N OLDEN AVENUE EXT
Practice Address - Street 2:STE. 9A
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-2111
Practice Address - Country:US
Practice Address - Phone:609-883-3444
Practice Address - Fax:609-883-6297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04023300261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE70394Medicare UPIN