Provider Demographics
NPI:1326426123
Name:SEBASTIANPETERMD
Entity Type:Organization
Organization Name:SEBASTIANPETERMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLEPRACTISE
Authorized Official - Prefix:DR
Authorized Official - First Name:SEBASTIAN
Authorized Official - Middle Name:AUGUSTINE
Authorized Official - Last Name:PETER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-871-8223
Mailing Address - Street 1:GORE STREET
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGES
Mailing Address - State:WESTINDIES
Mailing Address - Zip Code:00000
Mailing Address - Country:GD
Mailing Address - Phone:473-439-2327
Mailing Address - Fax:473-231-0905
Practice Address - Street 1:GORE STREET
Practice Address - Street 2:
Practice Address - City:SAINT GEORGES
Practice Address - State:WESTINDIES
Practice Address - Zip Code:00000
Practice Address - Country:GD
Practice Address - Phone:473-439-2327
Practice Address - Fax:473-231-0905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127078261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care