Healthcare Provider Details

I. General information

NPI: 1316902042
Provider Name (Legal Business Name): MONIKA ROSEMARY PEK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 NORTHERN BLVD STE 314
GREAT NECK NY
11021-4703
US

IV. Provider business mailing address

1014 SKI BLUFF TER
LAKE ARIEL PA
18436-8123
US

V. Phone/Fax

Practice location:
  • Phone: 516-829-6646
  • Fax: 516-829-0859
Mailing address:
  • Phone: 570-795-3950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMD428753
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD237826
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: