Provider Demographics
NPI:1073856357
Name:ANTOINE PEPELJUGOSKI, CRYSTAL VANESSA (MD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:VANESSA
Last Name:ANTOINE PEPELJUGOSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 THOMAS PL
Mailing Address - Street 2:
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1630
Mailing Address - Country:US
Mailing Address - Phone:516-581-9035
Mailing Address - Fax:
Practice Address - Street 1:HSC LEVEL 16 020
Practice Address - Street 2:DEPARTMENT OF MEDICINE SUNY STONY BROOK
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8160
Practice Address - Country:US
Practice Address - Phone:631-444-7411
Practice Address - Fax:631-444-2493
Is Sole Proprietor?:No
Enumeration Date:2013-04-04
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY286443207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program