Provider Demographics
NPI:1124210414
Name:PETERS, SUSAN (MS, RD, CDN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 BEEKMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CROTON ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10520-2557
Mailing Address - Country:US
Mailing Address - Phone:914-862-2208
Mailing Address - Fax:
Practice Address - Street 1:62 VALLEY RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-4355
Practice Address - Country:US
Practice Address - Phone:914-844-6026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001283-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
03P351Medicare PIN