Provider Demographics
NPI:1407841661
Name:PELNIK-FECKO, TRICIA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:ANN
Last Name:PELNIK-FECKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:ANN
Other - Last Name:FECKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1019 NEW LOUDON RD.
Mailing Address - Street 2:
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047
Mailing Address - Country:US
Mailing Address - Phone:518-262-7500
Mailing Address - Fax:518-262-7505
Practice Address - Street 1:1019 NEW LOUDON RD.
Practice Address - Street 2:
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047
Practice Address - Country:US
Practice Address - Phone:518-262-7500
Practice Address - Fax:518-262-7505
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217562208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02149237Medicaid
NYH33159Medicare UPIN
NY02149237Medicaid