Individual provider Active NPI

Anjelica Peacock, MD

  • Dermatology Physician
  • New York, NY
National Provider Identifier
1831651710
Registry record updated Feb 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
330446 Issued in NY
Practice address
214 Sullivan St
New York, NY 10012-1354
Phone
(212) 385-3700
NPI assigned
Apr 1, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 5, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 330446 NY Primary
General Practice Physician 208D00000X 35.142051 OH
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

214 Sullivan St
New York, NY 10012-1354

Mailing address

214 Sullivan St
New York, NY 10012-1354
Phone (212) 385-3700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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 1

Enrollment IDStateProvider typePAC IDDetails
I20260417001228 NY Practitioner - Dermatology 9638400047 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Wayne State University School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bobby Buka, M.D., P.C.Group PAC ID 0547351140, 140 clinicians

Practice addresses (Care Compare)

220 Front St
New York, NY 10038-2033
Phone (212) 385-3700

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
330446NYMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Derm Specs of PA PLLC Single Specialty CurrentSince Mar 15, 2026 Accepting new patients
Bobby Buka, M.D., P.C. Single Specialty CurrentSince Apr 1, 2007 Accepting new patients
Atlas Infectious Disease Practice PLLC Single Specialty Past Accepting new patients
Mount Sinai Hospital Past Accepting new patients
Out East Medical Single Specialty PastSince Jun 15, 2021 Accepting new patients

Locations

3179 Steinway St
Astoria, NY 11103

1163 Myrtle Ave
Brooklyn, NY 11206

625 10th Ave
New York, NY 10036

214 Sullivan St
New York, NY 10012

2121 Adam Clayton Powell Jr Blvd
New York, NY 10027
Phone (718) 534-8190

1425 2nd Ave
New York, NY 10021

3531 Long Beach Rd
Oceanside, NY 11572

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/22363/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir4.healow.com/fhir/r4/BFCDAA

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1554076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770249600000",
    "number": "1831651710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 SULLIVAN ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100121354",
            "telephone_number": "212-385-3700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 SULLIVAN ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100121354",
            "telephone_number": "212-385-3700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEACOCK",
        "first_name": "ANJELICA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-01",
        "last_updated": "2026-02-05",
        "certification_date": "2026-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "NY",
            "license": "330446",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "OH",
            "license": "35.142051",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.