Provider Demographics
NPI:1346445806
Name:ANASTASIOS PELIAS, M.D.,PC
Entity Type:Organization
Organization Name:ANASTASIOS PELIAS, M.D.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANASTASIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:PELIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-670-0212
Mailing Address - Street 1:2094 ELLIOT ST
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-5004
Mailing Address - Country:US
Mailing Address - Phone:516-670-0212
Mailing Address - Fax:
Practice Address - Street 1:2094 ELLIOT ST
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-5004
Practice Address - Country:US
Practice Address - Phone:516-670-0212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2179262086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Not Answered208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02105613Medicaid
NY04624Medicare ID - Type Unspecified
NY04624GMedicare ID - Type Unspecified
D06337Medicare UPIN
NY40B801Medicare ID - Type Unspecified
NY02105613Medicaid