Individual
MR. PAVEL ODINTSOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APN
Contact information
Practice address
182 S MAIN ST STE 106, NEW CITY, NY 10956-3318
(845) 358-4000
(201) 529-5913
Mailing address
20 GRAND ST, 3RD FL, WARWICK, NY 10990-1035
(845) 987-3906
(845) 987-5979
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
26NJ00337800
NJ
363LA2200X
Adult Health Nurse Practitioner
306748
NY
363LP2300X
Primary Care Nurse Practitioner
Primary
306748
NY
Other
Enumeration date
08/19/2011
Last updated
08/06/2024
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