Provider Demographics
NPI:1518018662
Name:PELLOWE, ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:
Last Name:PELLOWE
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 1:1 ELM PL
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-3927
Mailing Address - Country:US
Mailing Address - Phone:718-918-0660
Mailing Address - Fax:
Practice Address - Street 1:OLMMC, DEPARTMENT OF PSYCHIATRY
Practice Address - Street 2:4401 BRONX BOULEVARD
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470
Practice Address - Country:US
Practice Address - Phone:718-304-7060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1200352084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00832577Medicaid
NY00832577Medicaid
NYC08475Medicare UPIN