Individual provider Active NPI

Domenic Joseph Pedulla, MD

  • Anesthesiology Physician
  • New York, NY
National Provider Identifier
1528687613
Registry record updated Aug 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
335719 Issued in NY
Practice address
525 E 68TH St
New York, NY 10065-4870
Phone
(212) 746-2962
NPI assigned
Apr 9, 2020
Last updated
Aug 3, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 335719 NY Primary
Anesthesiology Physician 207L00000X 1019513 MA

Addresses

Primary practice location

525 E 68TH St
New York, NY 10065-4870

Mailing address

575 Lexington Ave
New York, NY 10022-6102

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, NY2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20241211002111 MA Practitioner - Anesthesiology 7810423092 Reassigns benefits to 1 organization
I20250812001926 NY Practitioner - Anesthesiology 7810423092 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Albert Einstein College of Medicine of Yeshiva University, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Weill Medical College of CornellGroup PAC ID 6800709023, 2,023 clinicians

Practice addresses (Care Compare)

525 E 68TH St
New York, NY 10065-4870
Phone (212) 746-2846

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
1019513MAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Brigham & Womens Physicians Organization Inc Anesthesiology CurrentSince Nov 3, 2024 Accepting new patients
Weill Medical College of Cornell CurrentSince Sep 1, 2025 Accepting new patients
Weill Medical College of Cornell Anesthesiology CurrentSince Sep 1, 2025 Accepting new patients

Locations

75 Francis St
Boston, MA 02115

62 13th St
Charlestown, MA 02129
Phone (617) 724-4260

170 William St
New York, NY 10038
Phone (212) 238-0100

525 E 68th St
New York, NY 10065
Phone (212) 746-2846

525 E 68th St
#124
New York, NY 10065
Phone (212) 746-2790

525 E 68th St
#585
New York, NY 10065
Phone (212) 746-2059

Interoperability endpoints

  • Direct secure messaging: djp9016@direct.nyp.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754179200000",
    "number": "1528687613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 LEXINGTON AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100226102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 E 68TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100654870",
            "telephone_number": "212-746-2962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDULLA",
        "first_name": "DOMENIC",
        "middle_name": "JOSEPH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-09",
        "last_updated": "2025-08-03",
        "certification_date": "2025-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "335719",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MA",
            "license": "1019513",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.