Healthcare Provider Details

I. General information

NPI: 1760431829
Provider Name (Legal Business Name): JAMES R PELLEGRINI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 AVENUE P
BROOKLYN NY
11229-1605
US

IV. Provider business mailing address

400 GLEN COVE AVE
SEA CLIFF NY
11579-2100
US

V. Phone/Fax

Practice location:
  • Phone: 718-338-7102
  • Fax: 718-338-1280
Mailing address:
  • Phone: 516-766-7556
  • Fax: 516-676-7534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number152142
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number152142
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number152142
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number152142
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: