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NPI Code Detail

MEDICARE: GUY J PEAN MD

MEDICARE: GUY J PEAN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207QA0401XAddiction Medicine (Family Medicine) Physician201871NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255442513
Entity Type Code : Individual
Provider Name (Legal Business Name) : GUY J PEAN MD
Provider Business Mailing Address
First Line : 721 E 48TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11203-5801
Country : US
Telephone Number : 718-451-1128
Fax Number :
Provider Business Practice Location Address
First Line : 177 E 122ND ST
Second Line :
City : NEW YORK
State : NY
Zip : 10035-2906
Country : US
Telephone Number : 212-360-7116
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 01/11/2013

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