Provider Demographics
NPI:1457580086
Name:PIERRE J. RENELIQUE MD PC
Entity Type:Organization
Organization Name:PIERRE J. RENELIQUE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:J
Authorized Official - Last Name:RENELIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-686-6700
Mailing Address - Street 1:6860 AUSTIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4245
Mailing Address - Country:US
Mailing Address - Phone:718-896-0999
Mailing Address - Fax:718-896-8502
Practice Address - Street 1:6860 AUSTIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4245
Practice Address - Country:US
Practice Address - Phone:718-896-0999
Practice Address - Fax:718-896-8502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181349207V00000X, 207ZC0006X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY181349OtherLICENSE