Provider Demographics
NPI:1205886009
Name:PESIN, JEFFREY L (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:PESIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3945
Mailing Address - Country:US
Mailing Address - Phone:732-906-0091
Mailing Address - Fax:732-906-0249
Practice Address - Street 1:106 JAMES ST
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3945
Practice Address - Country:US
Practice Address - Phone:732-906-0091
Practice Address - Fax:732-906-0249
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05777800207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6556701Medicaid
NJF29268Medicare UPIN
NJ725096Medicare ID - Type UnspecifiedPROVIDER NUMBER