Healthcare Provider Details

I. General information

NPI: 1447305446
Provider Name (Legal Business Name): VINCENT E PESIRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 71 STREET SUITE 620
MIAMI BEACH FL
33141-3089
US

IV. Provider business mailing address

300 71 STREET SUITE 620
MIAMI BEACH FL
33141-3080
US

V. Phone/Fax

Practice location:
  • Phone: 395-866-9951
  • Fax: 877-284-8933
Mailing address:
  • Phone: 516-759-2681
  • Fax: 516-671-3752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number146576
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number146576
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: