Provider Demographics
NPI:1982051793
Name:PASTINA, KATIE MARIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:PASTINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BEACH 105TH ST
Mailing Address - Street 2:APARTMENT 3E
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2695
Mailing Address - Country:US
Mailing Address - Phone:917-783-6988
Mailing Address - Fax:
Practice Address - Street 1:1 BEACH 105TH ST
Practice Address - Street 2:APARTMENT 3E
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2695
Practice Address - Country:US
Practice Address - Phone:917-783-6988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-21
Last Update Date:2016-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist