MEDICARE: DR. PEDRO SIERRA 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
1	208D00000X	General Practice Physician	1535411	NY

General Provider Information

NPI Number	:	1629014758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PEDRO SIERRA MD

Provider Business Mailing Address
First Line	:	210 W 101ST ST
Second Line	:	SUITE 11F
City	:	NEW YORK
State	:	NY
Zip	:	10025-5059
Country	:	US
Telephone Number	:	212-865-7507
Fax Number	:	212-865-7507

Provider Business Practice Location Address
First Line	:	210 W 101ST ST
Second Line	:	SUITE 11F
City	:	NEW YORK
State	:	NY
Zip	:	10025-5059
Country	:	US
Telephone Number	:	212-865-7507
Fax Number	:	212-865-7507

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	05/17/2026

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