Provider Demographics
NPI:1003991308
Name:ACKER, PETER JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JEFFREY
Last Name:ACKER
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 1:26 RYE RIDGE PLZ
Mailing Address - Street 2:
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-2820
Mailing Address - Country:US
Mailing Address - Phone:914-251-1100
Mailing Address - Fax:914-251-1109
Practice Address - Street 1:26 RYE RIDGE PLZ
Practice Address - Street 2:
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-2820
Practice Address - Country:US
Practice Address - Phone:914-251-1100
Practice Address - Fax:914-251-1109
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151842208000000X
CT028204208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WP820OtherOXFORD PROVIDER ID
13-3046781OtherTAX ID