Healthcare Provider Details

I. General information

NPI: 1629125232
Provider Name (Legal Business Name): STEVEN ALAN PELTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 MADISON AVE SUITE 3A
NEW YORK NY
10016-3823
US

IV. Provider business mailing address

118-21 QUEENS BLVD SUITE 601
FOREST HILLS NY
11375-7490
US

V. Phone/Fax

Practice location:
  • Phone: 646-424-0400
  • Fax: 646-742-0092
Mailing address:
  • Phone: 718-261-3663
  • Fax: 718-261-2285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number176064
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: