Provider Demographics
NPI:1770992836
Name:PELAYO, EMMANUEL A (A-GNP-C, RDN)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:A
Last Name:PELAYO
Suffix:
Gender:M
Credentials:A-GNP-C, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E 56TH ST # 92D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3607
Mailing Address - Country:US
Mailing Address - Phone:831-210-0313
Mailing Address - Fax:877-717-7942
Practice Address - Street 1:120 E 56TH ST # 92D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3607
Practice Address - Country:US
Practice Address - Phone:831-210-0313
Practice Address - Fax:877-717-7942
Is Sole Proprietor?:No
Enumeration Date:2014-08-03
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007794133V00000X
NYF310989-01363LG0600X, 363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care