Provider Demographics
NPI:1629067780
Name:PEDRE, VINCENT M (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:M
Last Name:PEDRE
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 1:120 E 56TH ST RM 530
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3674
Mailing Address - Country:US
Mailing Address - Phone:212-860-8300
Mailing Address - Fax:212-230-1828
Practice Address - Street 1:120 E 56TH ST RM 530
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3674
Practice Address - Country:US
Practice Address - Phone:212-860-8300
Practice Address - Fax:212-230-1828
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218249207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
12050137OtherMULTIPLAN
NY2382557OtherUNITED
NYP3154627OtherOXFORD
NY176396POtherHIP
NY3379083OtherAETNA HMO
NY3C6893OtherHEALTHNET
NY7423513OtherAETNA PPO/POS
NY9368302OtherCIGNA
NY800109864OtherPHCS
NY2382557OtherUNITED
NYA400006067Medicare PIN