1174622799 NPI number — DR. ARSENIO GEORGE PASCUAL M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174622799 NPI number — DR. ARSENIO GEORGE PASCUAL M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

PASCUAL

Provider First Name:

ARSENIO

Provider Middle Name:

GEORGE

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1174622799

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/18/2018

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

711 TROY SCHENECTADY RD STE 203

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

LATHAM

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

12110-2461

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

518-782-3700

Provider Business Mailing Address Fax Number:

518-782-3799

Provider First Line Business Practice Location Address:

942A ROUTE 146

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

CLIFTON PARK

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

12065-3614

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

518-371-8000

Provider Business Practice Location Address Fax Number:

518-371-5338

Provider Enumeration Date:

09/21/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2080P0006X , with the licence number:  177332 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208000000X , with the licence number: 177332 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 070125000007 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 200392 . This is a "SENIOR WHOLE HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 01276008 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 10006144 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 000401615014 . This is a "BSNENY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 5179302 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 711042 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 582Y42 . This is a "EMPIRE BC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 72653 . This is a "GHI/HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 070803000060 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".