Healthcare Provider Details

I. General information

NPI: 1255442513
Provider Name (Legal Business Name): GUY J PEAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 E 122ND ST
NEW YORK NY
10035-2906
US

IV. Provider business mailing address

721 E 48TH ST
BROOKLYN NY
11203-5801
US

V. Phone/Fax

Practice location:
  • Phone: 212-360-7116
  • Fax:
Mailing address:
  • Phone: 718-451-1128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number201871
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: