Provider Demographics
NPI:1134349111
Name:PELC, BARBARA ANN (DPM)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:ANN
Last Name:PELC
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:MRS
Other - First Name:BARBARA
Other - Middle Name:ANN
Other - Last Name:VOLPE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:---
Mailing Address - Street 1:57 THE PROMENADE
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-1739
Mailing Address - Country:US
Mailing Address - Phone:516-759-6115
Mailing Address - Fax:516-676-0981
Practice Address - Street 1:57 THE PROMENADE
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-1739
Practice Address - Country:US
Practice Address - Phone:516-759-6115
Practice Address - Fax:516-676-0981
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003597213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP39631Medicare ID - Type Unspecified