Provider Demographics
NPI:1386353688
Name:PIELAGO, JOHN ALBERT DELFIN
Entity type:Individual
Prefix:
First Name:JOHN ALBERT
Middle Name:DELFIN
Last Name:PIELAGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:ALBERT
Other - Last Name:PIELAGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:14403 BARCLAY AVE APT 1C
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-1552
Mailing Address - Country:US
Mailing Address - Phone:646-424-1899
Mailing Address - Fax:
Practice Address - Street 1:14403 BARCLAY AVE APT 1C
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-1552
Practice Address - Country:US
Practice Address - Phone:646-424-1899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 390200000X
NY02082022163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No251B00000XAgenciesCase Management
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program