Provider Demographics
NPI:1306074091
Name:ANDRESITO B. PACIS MD P.C
Entity type:Organization
Organization Name:ANDRESITO B. PACIS MD P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDRESITO
Authorized Official - Middle Name:B
Authorized Official - Last Name:PACIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-933-6969
Mailing Address - Street 1:3130 GRAND CONCOURSE SUITE 1P
Mailing Address - Street 2:ATTN MOSHOLU PARK RADIOLOGY
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458
Mailing Address - Country:US
Mailing Address - Phone:718-933-6969
Mailing Address - Fax:718-933-6970
Practice Address - Street 1:3130 GRAND CONCOURSE SUITE 1P
Practice Address - Street 2:ANDRESITO B. PACIS MD P.C ATTN MOSHOLU PARK RADIOLOGY
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458
Practice Address - Country:US
Practice Address - Phone:718-933-6969
Practice Address - Fax:718-933-6970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty