Basic Information
Provider Information | |||||||||
NPI: | 1811162076 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PACHOLSKI | ||||||||
FirstName: | MICHAEL | ||||||||
MiddleName: | T | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | APRN, CRNA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 68 S SERVICE RD | ||||||||
Address2: | SUITE 350 | ||||||||
City: | MELVILLE | ||||||||
State: | NY | ||||||||
PostalCode: | 117472354 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5169453000 | ||||||||
FaxNumber: | 5169453131 | ||||||||
Practice Location | |||||||||
Address1: | 100 GRAND ST | ||||||||
Address2: |   | ||||||||
City: | NEW BRITAIN | ||||||||
State: | CT | ||||||||
PostalCode: | 060522016 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8602245266 | ||||||||
FaxNumber: | 8605630741 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/28/2008 | ||||||||
LastUpdateDate: | 03/19/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | CP43081 | CT | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   | 367500000X | 3784 | CT | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   |
No ID Information.