Provider Demographics
NPI:1194817783
Name:PELINA, BUENAVENTURA I (MD)
Entity Type:Individual
Prefix:DR
First Name:BUENAVENTURA
Middle Name:I
Last Name:PELINA
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 1:244 BUEL AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-1204
Mailing Address - Country:US
Mailing Address - Phone:718-351-9389
Mailing Address - Fax:
Practice Address - Street 1:244 BUEL AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-1204
Practice Address - Country:US
Practice Address - Phone:718-351-9389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131424208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00609105Medicaid
NYB17049Medicare UPIN