Provider Demographics
NPI:1851121610
Name:PAVEL ODINTSOV NP IN ADULT HEALTH PLLC
Entity type:Organization
Organization Name:PAVEL ODINTSOV NP IN ADULT HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:PAVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ODINTSOV
Authorized Official - Suffix:
Authorized Official - Credentials:ADULT-NP, PMHNP
Authorized Official - Phone:201-665-4150
Mailing Address - Street 1:297 HILLSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07642-2212
Mailing Address - Country:US
Mailing Address - Phone:201-665-4150
Mailing Address - Fax:
Practice Address - Street 1:182 S MAIN ST STE 106
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3318
Practice Address - Country:US
Practice Address - Phone:845-358-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAVEL ODINTSOV NP IN ADULT HEALTH AND PSYCHIATRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty