Healthcare Provider Details

I. General information

NPI: 1093154940
Provider Name (Legal Business Name): NEIL OLIVER PEDLEY LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14410 JAMAICA AVE
JAMAICA NY
11435-3624
US

IV. Provider business mailing address

2701 38TH AVE 2ND FLOOR
LONG ISLAND CITY NY
11101-2603
US

V. Phone/Fax

Practice location:
  • Phone: 718-206-1990
  • Fax:
Mailing address:
  • Phone: 718-360-0938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number087773
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: