MEDICARE: NANDO PELUSI, PHD

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	320800000X	Mental Illness Community Based Residential Treatment Facility	011392	NY

General Provider Information

NPI Number	:	1679011530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NANDO PELUSI, PHD

Provider Business Mailing Address
First Line	:	305 HICKS ST
Second Line	:	2
City	:	BROOKLYN
State	:	NY
Zip	:	11201-4557
Country	:	US
Telephone Number	:	718-852-1961
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 HICKS STREET
Second Line	:	2
City	:	BROOKYN
State	:	NY
Zip	:	11201
Country	:	US
Telephone Number	:	718-852-1961
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. NANDO PELUSI
Credential	:	PH.D.
Telephone Number	:	917-826-2012

Provider Enumeration Date	:	02/10/2017
Last Update Date	:	02/10/2017

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