Provider Demographics
NPI:1912081050
Name:PASTORE, SUZANNE I (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:I
Last Name:PASTORE
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 1:38 MARYLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-2611
Mailing Address - Country:US
Mailing Address - Phone:917-207-5203
Mailing Address - Fax:646-962-0599
Practice Address - Street 1:2 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-4137
Practice Address - Country:US
Practice Address - Phone:646-962-4676
Practice Address - Fax:646-962-0599
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215527207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
699252Medicare UPIN
NY51Z71Medicare ID - Type Unspecified