Provider Demographics
NPI:1619975943
Name:PELCOVITZ, NACHUM (DPM)
Entity Type:Individual
Prefix:DR
First Name:NACHUM
Middle Name:
Last Name:PELCOVITZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 WILDACRE AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1414
Mailing Address - Country:US
Mailing Address - Phone:516-239-8300
Mailing Address - Fax:516-371-9418
Practice Address - Street 1:183 WILDACRE AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1414
Practice Address - Country:US
Practice Address - Phone:516-239-8300
Practice Address - Fax:516-371-9418
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2007-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN3598213E00000X
CTP00384213E00000X
NJ25MD00179200213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0586102Medicaid
NY00792609Medicaid
NYT51124Medicare UPIN
NY02803Medicare PIN
NJ012412QQ7Medicare PIN
NYP37232Medicare ID - Type Unspecified