Provider Demographics
NPI:1104840503
Name:PASLEY, PETER M (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:M
Last Name:PASLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:PO BOX 43420
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-0420
Mailing Address - Country:US
Mailing Address - Phone:917-656-3087
Mailing Address - Fax:212-254-3243
Practice Address - Street 1:29 WASHINGTON SQ W
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-9180
Practice Address - Country:US
Practice Address - Phone:212-982-5551
Practice Address - Fax:212-254-3243
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY217034207R00000X
NJ25MA09044800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02184178Medicaid
NY02184178Medicaid
NYH13970Medicare UPIN