Provider Demographics
NPI:1497815773
Name:PEKARSKY, LYUDMILA (MD)
Entity Type:Individual
Prefix:DR
First Name:LYUDMILA
Middle Name:
Last Name:PEKARSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3120
Mailing Address - Country:US
Mailing Address - Phone:732-972-2805
Mailing Address - Fax:
Practice Address - Street 1:356 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-2306
Practice Address - Country:US
Practice Address - Phone:718-667-6354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1673372080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA64339Medicare UPIN