Individual provider · Type 1 NPI
Pavel Odintsov, APN
Primary Care Nurse Practitioner · New City, NY
NPI number
1073893178
Active
Practice location
182 S Main St Ste 106
New City, NY 10956-3318
Fax (201) 529-5913
Mailing address
20 Grand St, 3rd Fl
Warwick, NY 10990-1035
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 306748 (NY) |
| Adult Health Nurse Practitioner | 363LA2200X | 26NJ00337800 (NJ) |
| Primary Care Nurse Practitioner Primary | 363LP2300X | 306748 (NY) |
Primary Care Nurse Practitioner: Definition to come...
Another provider at this address
About NPI 1073893178
Pavel Odintsov, APN's National Provider Identifier is 1073893178, issued on Aug 19, 2011. The primary taxonomy on file is Primary Care Nurse Practitioner (363LP2300X), and the practice location is in New City, NY. The record was last updated on Aug 6, 2024.