Provider Demographics
NPI:1366852576
Name:PELOS, JOHN PHILIP
Entity type:Individual
Prefix:
First Name:JOHN PHILIP
Middle Name:
Last Name:PELOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6224 FORT HAMILTON PKWY APT A3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-5117
Mailing Address - Country:US
Mailing Address - Phone:347-420-7743
Mailing Address - Fax:
Practice Address - Street 1:6224 FORT HAMILTON PKWY APT A3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-5117
Practice Address - Country:US
Practice Address - Phone:347-420-7743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037307225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist