Basic Information
| Provider Information | |||||||||
| NPI: | 1700917952 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PASCUAL | ||||||||
| FirstName: | JAY | ||||||||
| MiddleName: | KRIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7245 52ND AVE APT 1 | ||||||||
| Address2: | |||||||||
| City: | MASPETH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113781571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185272068 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 227 W 19TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100114001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125632627 | ||||||||
| FaxNumber: | 2125630605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 04/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 207016 | NY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | 207016 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 22101 | WI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01818033 | 05 | NY | MEDICAID |