Provider Demographics
NPI:1972757672
Name:JOHN M PEPE MD PLLC
Entity Type:Organization
Organization Name:JOHN M PEPE MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-982-7800
Mailing Address - Street 1:1550 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1578
Mailing Address - Country:US
Mailing Address - Phone:718-982-7800
Mailing Address - Fax:
Practice Address - Street 1:1550 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1578
Practice Address - Country:US
Practice Address - Phone:718-982-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-07
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100000966Medicare PIN