Provider Demographics
NPI:1023131844
Name:PASTERNAK, SUSAN WEIGEL (DMH)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:WEIGEL
Last Name:PASTERNAK
Suffix:
Gender:F
Credentials:DMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 DUANE ST
Mailing Address - Street 2:APT 5
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3397
Mailing Address - Country:US
Mailing Address - Phone:212-219-8384
Mailing Address - Fax:
Practice Address - Street 1:9 DESBROSSES ST
Practice Address - Street 2:SUITE 406
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-1701
Practice Address - Country:US
Practice Address - Phone:212-548-2394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016382174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist