| Doctor Name: | MR. PAVEL ODINTSOV |
| NPI Number: | 1073893178 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | APN |
| License Number: | 306748 |
| Business Practice Address: | 10 Franklin Tpke Mahwah, NJ - 074301304 |
| Business Phone Number: | 2015290033 |
| Business Fax Number: | 2015295913 |
| Mailing Address: | 20 Grand St, 3rd Fl WARWICK |
| State: | NY |
| Postal Code: | 109901035 |
| Phone Number: | 8459873906 |
| Fax Number: | 8459875979 |
| NPI Enumeration Date: | 08/19/2011 |
| NPI Last Update Date: | 09/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 306748 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |