Provider Demographics
NPI:1356776488
Name:PELVOV, INC
Entity type:Organization
Organization Name:PELVOV, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER, PELVOV, INC.
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-267-8063
Mailing Address - Street 1:PO BOX 6227
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-0227
Mailing Address - Country:US
Mailing Address - Phone:718-932-8700
Mailing Address - Fax:
Practice Address - Street 1:3096 36TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-4705
Practice Address - Country:US
Practice Address - Phone:718-932-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0322683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY032268OtherNYS BOARD OF PHARMACY
NY03957724Medicaid
NY03957724Medicaid