MEDICARE: JAMES R PELLEGRINI 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	207K00000X	Allergy & Immunology Physician	152142	NY
2	207KA0200X	Allergy Physician	152142	NY
3	207R00000X	Internal Medicine Physician	152142	NY
4	207RA0201X	Allergy & Immunology (Internal Medicine) Physician	152142	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	152142	OTHER	NY	NEW YORK LICENSE

General Provider Information

NPI Number	:	1760431829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES R PELLEGRINI MD

Provider Business Mailing Address
First Line	:	400 GLEN COVE AVE
Second Line	:
City	:	SEA CLIFF
State	:	NY
Zip	:	11579-2100
Country	:	US
Telephone Number	:	516-766-7556
Fax Number	:	516-676-7534

Provider Business Practice Location Address
First Line	:	2405 AVENUE P
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1605
Country	:	US
Telephone Number	:	718-338-7102
Fax Number	:	718-338-1280

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	06/17/2025

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