Provider Demographics
NPI:1043215387
Name:PEPE, ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:PEPE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W 59TH ST
Mailing Address - Street 2:STE 8B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1104
Mailing Address - Country:US
Mailing Address - Phone:212-376-3180
Mailing Address - Fax:212-376-3190
Practice Address - Street 1:425 W 59TH ST
Practice Address - Street 2:STE 8B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1104
Practice Address - Country:US
Practice Address - Phone:212-376-3180
Practice Address - Fax:212-376-3190
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110775-1207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00245923Medicaid
NYB12832Medicare UPIN
NY317251Medicare ID - Type Unspecified