Provider Demographics
NPI:1003183658
Name:PETERSON MEDICAL SUPPLY COMPANY
Entity Type:Organization
Organization Name:PETERSON MEDICAL SUPPLY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:BAEKELAND
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-324-3200
Mailing Address - Street 1:PO BOX 2835
Mailing Address - Street 2:
Mailing Address - City:AMAGANSETT
Mailing Address - State:NY
Mailing Address - Zip Code:11930-2835
Mailing Address - Country:US
Mailing Address - Phone:631-324-3200
Mailing Address - Fax:631-324-3676
Practice Address - Street 1:400 PANTIGO RD
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937-2699
Practice Address - Country:US
Practice Address - Phone:631-324-3200
Practice Address - Fax:631-324-3676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies