Provider Demographics
NPI:1245203892
Name:PETERSON, STEPHEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:PETERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:506 SIXTH STREET
Mailing Address - Street 2:NYMH DEPT OF MEDICINE
Mailing Address - City:BROOKLN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-9008
Mailing Address - Country:US
Mailing Address - Phone:718-780-5246
Mailing Address - Fax:718-780-3259
Practice Address - Street 1:506 SIXTH STREET
Practice Address - Street 2:NYMH DEPARTMENT OF MEDICINE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-9008
Practice Address - Country:US
Practice Address - Phone:718-780-5246
Practice Address - Fax:718-780-3259
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2022-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY165002207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01009365Medicaid
NY110123567OtherRAILROAD MEDICARE
NY68D251OtherBCBS OF NY WHITE PLAINS
NYWP722OtherOXFORD
NY4622237OtherAETNA PPO
NY0492111OtherAETNA HMO
NY1201593OtherUNITED HEALTHCARE
NY4622237OtherAETNA PPO