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General NPI Number Information
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NPI Number | 1013923028
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Entity Type | Individual
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Provider Name | ELY D PELTA M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 10/19/2012
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Provider Practice Location Address
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Address Line | 5441 N UNIVERSITY DR SUITE 102
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City | CORAL SPRINGS
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State | FL
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Zip | 33067-4640
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Country | US
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Telephone | 954-345-8733
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Fax | 954-345-8233
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Provider Business Mailing Address
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Address Line | 5441 N UNIVERSITY DR SUITE 102
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City | CORAL SPRINGS
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State | FL
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Zip | 33067-4640
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Country | US
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Telephone | 954-345-8733
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Fax | 954-345-8233
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME59840
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License Number State | FL
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