Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 152142 | NY |
NPI | 1760431829 |
---|---|
Provider Name | James R Pellegrini |
First Address | Sea Cliff, NY 11579-2100 |
Second Address | Brooklyn, NY 11234-2605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 29/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01850724 | (05) | NY |
152142 | NEW YORK LICENSE (01) | NY |
C12132 | (02) | NY |