Provider Demographics
NPI:1447305446
Name:PESIRI, VINCENT E (MD)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:E
Last Name:PESIRI
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 1:300 71 STREET
Mailing Address - Street 2:SUITE 620
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-3080
Mailing Address - Country:US
Mailing Address - Phone:516-759-2681
Mailing Address - Fax:516-671-3752
Practice Address - Street 1:300 71 STREET
Practice Address - Street 2:SUITE 620
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-3089
Practice Address - Country:US
Practice Address - Phone:395-866-9951
Practice Address - Fax:877-284-8933
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY146576207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0096213Medicaid
NY0096213Medicaid
NYA400020647Medicare PIN
NY64D061Medicare PIN