Provider Demographics
NPI:1144262510
Name:PELHAM PHYSICAL MEDICINE,INC
Entity type:Organization
Organization Name:PELHAM PHYSICAL MEDICINE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PERLMUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-823-3900
Mailing Address - Street 1:2118 WILLIAMSBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1602
Mailing Address - Country:US
Mailing Address - Phone:718-823-3900
Mailing Address - Fax:718-823-3961
Practice Address - Street 1:2118 WILLIAMSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1602
Practice Address - Country:US
Practice Address - Phone:718-823-3900
Practice Address - Fax:718-823-3961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0019351111N00000X
NY205143-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02382052Medicaid
NY595932Medicare ID - Type UnspecifiedDR. PEKOVIC PROVIDER #
NYW85541Medicare ID - Type UnspecifiedGROUP NUMBER
NYX5J461Medicare ID - Type UnspecifiedDR.PERLMUUTER PROVIDER #
NY02382052Medicaid
NYQ27E01Medicare ID - Type UnspecifiedARVIN ILAGAN PROVIDER #