Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 25MA04145900 | NJ |
N | 207W00000X | Ophthalmologist | MD022603E | PA |
NPI | 1033156344 |
---|---|
Provider Name | Dr. Raymond Pekala |
First Address | Haddon Heights, NJ 08035-1703 |
Second Address | Haddon Heights, NJ 08035-1703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 04/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0077699000 | AMERIHEALTH PROVIDER (01) | |
17715 | AETNA PROVIDER (01) | |
C53063 | (02) |