Provider Demographics
NPI:1093156994
Name:O'NEILL, PETER (CO)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 FLEETS POINT DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-8314
Mailing Address - Country:US
Mailing Address - Phone:631-321-5000
Mailing Address - Fax:631-321-5004
Practice Address - Street 1:60 FLEETS POINT DR
Practice Address - Street 2:SUITE 3
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-8314
Practice Address - Country:US
Practice Address - Phone:631-321-5000
Practice Address - Fax:631-321-5004
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC22025222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist