Provider Demographics
NPI:1649363367
Name:PASTORE, RAYMOND J (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:J
Last Name:PASTORE
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 1:282 N. CORONA AVE.
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580
Mailing Address - Country:US
Mailing Address - Phone:516-872-0111
Mailing Address - Fax:516-825-2415
Practice Address - Street 1:282 N. CORONA AVE.
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580
Practice Address - Country:US
Practice Address - Phone:516-872-0111
Practice Address - Fax:516-825-2415
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103104-1207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400047462OtherEMPIRE
NYRP05797810Medicare PIN
NY05113GMedicare PIN
NYB78054Medicare UPIN