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NPI Code Detail

MEDICARE: PETER CORONEL PASTOLERO M.D.

MEDICARE: PETER CORONEL PASTOLERO M.D.
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
1208000000XPediatrics Physician300330NY

General Provider Information

NPI Number : 1942652649
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER CORONEL PASTOLERO M.D.
Provider Business Mailing Address
First Line : 439 PORT RICHMOND AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10302-1714
Country : US
Telephone Number : 718-924-2254
Fax Number :
Provider Business Practice Location Address
First Line : 439 PORT RICHMOND AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10302-1714
Country : US
Telephone Number : 718-924-2254
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2016
Last Update Date : 07/28/2022

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