Provider Demographics
NPI:1588704019
Name:SARTI, PELLEGRINO JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:PELLEGRINO
Middle Name:JOHN
Last Name:SARTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 29 70TH STREET
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3927
Mailing Address - Country:US
Mailing Address - Phone:718-458-4156
Mailing Address - Fax:
Practice Address - Street 1:1150 FIFTH AVENUE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-0724
Practice Address - Country:US
Practice Address - Phone:212-427-5595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1417812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY49A74OtherBLUE CROSS BLUE SHIELD
D47594Medicare UPIN
NY49A741Medicare ID - Type Unspecified