Healthcare Provider Details

I. General information

NPI: 1942267539
Provider Name (Legal Business Name): STEVEN JOHN PESCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 04/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

492 MONTAUK HWY
EAST MORICHES NY
11940-1347
US

IV. Provider business mailing address

STONY BROOK UNIVERSITY MEDICAL CTR HSC T-11, ROOM 020
STONY BROOK NY
11794-8111
US

V. Phone/Fax

Practice location:
  • Phone: 631-638-2900
  • Fax: 631-878-8083
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number188632
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: