Provider Demographics
NPI:1063483154
Name:SCHLOSSBERG, PETER (MD)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:SCHLOSSBERG
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 1:630 W 168TH ST
Mailing Address - Street 2:MC28 COLUMBIA PRESBYTERIAN RADIOLOGY
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032
Mailing Address - Country:US
Mailing Address - Phone:212-305-1948
Mailing Address - Fax:212-305-5777
Practice Address - Street 1:622 W 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-305-9335
Practice Address - Fax:212-305-8626
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME833782085R0204X
NY14350112085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1467560854OtherGROUP NPI#
NYW35021OtherGROUP MEDICARE#
NY01610219Medicaid
NY02186203OtherGROUP MEDICAID
NYA62592Medicare UPIN
NY02186203OtherGROUP MEDICAID