Provider Demographics
NPI:1083638118
Name:PELAEZ, STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:PELAEZ
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 1:1100 FRANKLIN AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-3221
Mailing Address - Country:US
Mailing Address - Phone:516-248-2422
Mailing Address - Fax:516-248-5162
Practice Address - Street 1:1100 FRANKLIN AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-3221
Practice Address - Country:US
Practice Address - Phone:516-248-2422
Practice Address - Fax:516-248-5162
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170044-1208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY92F031Medicare PIN
NYE94769Medicare UPIN