Provider Demographics
NPI:1922170646
Name:PIERRE RENELIQUE MD PC
Entity Type:Organization
Organization Name:PIERRE RENELIQUE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:
Authorized Official - Last Name:RENELIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-466-4772
Mailing Address - Street 1:714 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:870 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4660
Practice Address - Country:US
Practice Address - Phone:718-466-4772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1813491174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01200788Medicaid
NY01200788Medicaid
NY01609AMedicare ID - Type Unspecified
NY83F083Medicare ID - Type Unspecified