1295964401 NPI number — MRS. AWILDA PELAEZ LMT

Table of content: MRS. AWILDA PELAEZ LMT (NPI 1295964401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295964401 NPI number — MRS. AWILDA PELAEZ LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PELAEZ
Provider First Name:
AWILDA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295964401
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700-60 PATCHOGUE-YAPHANK ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDFORD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11763
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-380-1893
Provider Business Mailing Address Fax Number:
631-775-8449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 PATCHOGUE YAPHANK RD STE 60
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDFORD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11763-2239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-380-1893
Provider Business Practice Location Address Fax Number:
631-775-8449
Provider Enumeration Date:
07/09/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 172M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)