Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 127898 | NY |
NPI | 1013009349 |
---|---|
Provider Name | John M Pepe |
First Address | Staten Island, NY 10306-2364 |
Second Address | Staten Island, NY 10314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 17/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00848884 | (05) | NY |
B80540 | (02) | NY |