Provider Demographics
NPI:1275630170
Name:JURMANN, PETER J
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:J
Last Name:JURMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 DOWSING PL
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-3719
Mailing Address - Country:US
Mailing Address - Phone:631-598-0147
Mailing Address - Fax:631-598-4823
Practice Address - Street 1:5 DOWSING PL
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-3719
Practice Address - Country:US
Practice Address - Phone:631-598-0147
Practice Address - Fax:631-598-4823
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR056783-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNE2191Medicare PIN