Provider Demographics
NPI:1871822346
Name:PASTENA, GAETANO THOMAS (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:GAETANO
Middle Name:THOMAS
Last Name:PASTENA
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:DR
Other - First Name:GAETANO
Other - Middle Name:THOMAS
Other - Last Name:PASTENA
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD, MBA
Mailing Address - Street 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2442
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:47 NEW SCOTLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3412
Practice Address - Country:US
Practice Address - Phone:518-262-3277
Practice Address - Fax:518-262-4210
Is Sole Proprietor?:No
Enumeration Date:2009-12-13
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2429452085R0202X
NY2655802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03466942Medicaid
NYJ400076222Medicare PIN