Provider Demographics
NPI:1720090673
Name:PEKLER, GERALD (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:PEKLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MARIAN
Other - Middle Name:
Other - Last Name:DAVID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:12510 QUEENS BLVD
Mailing Address - Street 2:SUITE 2701
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1519
Mailing Address - Country:US
Mailing Address - Phone:718-261-0444
Mailing Address - Fax:718-261-0940
Practice Address - Street 1:12510 QUEENS BLVD
Practice Address - Street 2:SUITE 2701
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1519
Practice Address - Country:US
Practice Address - Phone:718-261-0444
Practice Address - Fax:718-261-0940
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144419207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00792663Medicaid
NYB14090Medicare UPIN
NY00792663Medicaid