Basic Information
Provider Information
NPI: 1124238035
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PASTERNAK
FirstName: ROBERT
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 551420
Address2:  
City: FORT LAUDERDALE
State: FL
PostalCode: 333551420
CountryCode: US
TelephoneNumber: 8002433839
FaxNumber: 9548392569
Practice Location
Address1: 4725 N FEDERAL HWY
Address2:  
City: FORT LAUDERDALE
State: FL
PostalCode: 333084603
CountryCode: US
TelephoneNumber: 9544935005
FaxNumber: 9549380957
Other Information
ProviderEnumerationDate: 05/23/2007
LastUpdateDate: 08/14/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X248483NYN Allopathic & Osteopathic PhysiciansAnesthesiology 
207L00000XME116311FLY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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