Healthcare Provider Details

I. General information

NPI: 1003932849
Provider Name (Legal Business Name): JOSE ABEL PELAEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 AUDUBON AVE
NEW YORK NY
10032
US

IV. Provider business mailing address

4051 68TH ST
WOODSIDE NY
11377-3831
US

V. Phone/Fax

Practice location:
  • Phone: 212-342-4700
  • Fax: 212-342-4725
Mailing address:
  • Phone: 718-639-2473
  • Fax: 212-342-4725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number130084
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: