Provider Demographics
NPI:1013095694
Name:PASTENA, JANIS A (MD)
Entity Type:Individual
Prefix:DR
First Name:JANIS
Middle Name:A
Last Name:PASTENA
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 1:100 WOODS ROAD
Mailing Address - Street 2:NYMC DEPT. OF SURGERY, MUNGER PAVILION
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595
Mailing Address - Country:US
Mailing Address - Phone:914-261-7319
Mailing Address - Fax:914-593-1802
Practice Address - Street 1:100 WOODS ROAD
Practice Address - Street 2:NYMC DEPT. OF SURGERY, MUNGER PAVILION
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595
Practice Address - Country:US
Practice Address - Phone:914-261-7319
Practice Address - Fax:914-593-1802
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146287208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01223752Medicaid
NYA400001843Medicare PIN
NY01223752Medicaid
NYA100000251Medicare PIN