Healthcare Provider Details

I. General information

NPI: 1871713776
Provider Name (Legal Business Name): ANN LOUISE PEDERSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANN LOUISE PETERSEN

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 EAST 210TH STREET MONTEFIORE MEDICAL CENTER
BRONX NY
10467-2490
US

IV. Provider business mailing address

111 EAST 210TH STREET MONTEFIORE MEDICAL CENTER
BRONX NY
10467-2490
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-4083
  • Fax: 718-920-5048
Mailing address:
  • Phone: 718-920-4083
  • Fax: 718-920-5048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number241603
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: