Provider Demographics
NPI:1780380154
Name:PELEX, INC
Entity type:Organization
Organization Name:PELEX, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WIYGUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-684-0176
Mailing Address - Street 1:300 BEVERLY RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11363-1125
Mailing Address - Country:US
Mailing Address - Phone:347-684-0176
Mailing Address - Fax:
Practice Address - Street 1:300 BEVERLY RD
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11363-1125
Practice Address - Country:US
Practice Address - Phone:347-684-0176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty