Provider Demographics
NPI:1528278967
Name:PELACCIO, ERNEST JOHN JR (MD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:JOHN
Last Name:PELACCIO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JACK
Other - Middle Name:
Other - Last Name:PELACCIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:80 WOOSTER ST APT 5R
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-4493
Mailing Address - Country:US
Mailing Address - Phone:646-410-6541
Mailing Address - Fax:
Practice Address - Street 1:80 WOOSTER ST APT 5R
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-4493
Practice Address - Country:US
Practice Address - Phone:646-410-6541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126799102L00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC08123Medicare UPIN