Provider Demographics
NPI:1073533634
Name:O'NEILL, PETER E (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:E
Last Name:O'NEILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:226 7TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5723
Mailing Address - Country:US
Mailing Address - Phone:516-739-1141
Mailing Address - Fax:516-248-6435
Practice Address - Street 1:226 7TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5723
Practice Address - Country:US
Practice Address - Phone:516-739-1141
Practice Address - Fax:516-248-6435
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY173798207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY72F962Medicare PIN