Provider Demographics
NPI:1649524851
Name:EDWARD J. PAKSTIS, M.D., P.L.L.C.
Entity type:Organization
Organization Name:EDWARD J. PAKSTIS, M.D., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAKSTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-678-6816
Mailing Address - Street 1:94 TARENCE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-2621
Mailing Address - Country:US
Mailing Address - Phone:516-678-6816
Mailing Address - Fax:
Practice Address - Street 1:94 TARENCE ST
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-2621
Practice Address - Country:US
Practice Address - Phone:516-678-6816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-09
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160126-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY18E563Medicare PIN
NY64090Medicare PIN