Provider Demographics
NPI:1922194885
Name:PELZIG, NAOMI (MD)
Entity Type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:
Last Name:PELZIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-3204
Mailing Address - Country:US
Mailing Address - Phone:845-642-4016
Mailing Address - Fax:845-535-3446
Practice Address - Street 1:42 MAIN ST
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-3204
Practice Address - Country:US
Practice Address - Phone:845-642-4016
Practice Address - Fax:845-535-3446
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146693208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY146693-7OtherWORKERS COMPENSATION BOAR
NYP413284OtherOXFORD
NY01347144Medicaid
NYE86359Medicare UPIN
NY01347144Medicaid