Healthcare Provider Details

I. General information

NPI: 1972757672
Provider Name (Legal Business Name): JOHN M PEPE MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2008
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 RICHMOND AVE
STATEN ISLAND NY
10314-1578
US

IV. Provider business mailing address

1550 RICHMOND AVE
STATEN ISLAND NY
10314-1578
US

V. Phone/Fax

Practice location:
  • Phone: 718-982-7800
  • Fax:
Mailing address:
  • Phone: 718-982-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN PEPE
Title or Position: DIRECTOR
Credential:
Phone: 718-982-7800