Provider Demographics
NPI:1336163591
Name:PASTRICH, HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:
Last Name:PASTRICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 PATCHOGUE YAPHANK RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:E PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4886
Mailing Address - Country:US
Mailing Address - Phone:631-289-0300
Mailing Address - Fax:631-289-0402
Practice Address - Street 1:260 PATCHOGUE YAPHANK RD
Practice Address - Street 2:SUITE C
Practice Address - City:E PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4886
Practice Address - Country:US
Practice Address - Phone:631-289-0300
Practice Address - Fax:631-289-0402
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146972207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01097350Medicaid
NY100003057OtherRAILROAD MEDICARE
NY01097350Medicaid
NY100003057Medicare PIN