Provider Demographics
NPI:1558691915
Name:PEDISICH, DOROTHY ELIZABETH (PA)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:ELIZABETH
Last Name:PEDISICH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:DOROTHY
Other - Middle Name:ELIZABETH
Other - Last Name:RADOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 29234
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-0234
Mailing Address - Country:US
Mailing Address - Phone:212-606-1642
Mailing Address - Fax:
Practice Address - Street 1:535 E 70TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4823
Practice Address - Country:US
Practice Address - Phone:212-606-1642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical