Provider Demographics
NPI:1679011530
Name:NANDO PELUSI, PHD
Entity Type:Organization
Organization Name:NANDO PELUSI, PHD
Other - Org Name:DR. PELUSI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PELUSI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:917-826-2012
Mailing Address - Street 1:305 HICKS ST
Mailing Address - Street 2:2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4557
Mailing Address - Country:US
Mailing Address - Phone:718-852-1961
Mailing Address - Fax:
Practice Address - Street 1:305 HICKS STREET
Practice Address - Street 2:2
Practice Address - City:BROOKYN,
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-852-1961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. PELUSI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011392320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness