Provider Demographics
NPI:1336103761
Name:VAN DER RIET, PETER N (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:N
Last Name:VAN DER RIET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3050 ROUTE 50
Mailing Address - Street 2:FL 2
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-2958
Mailing Address - Country:US
Mailing Address - Phone:607-547-3909
Mailing Address - Fax:607-547-6325
Practice Address - Street 1:1 ATWELL RD
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-1301
Practice Address - Country:US
Practice Address - Phone:607-547-3909
Practice Address - Fax:607-547-6325
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY001809207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02365066Medicaid
NYH78027Medicare UPIN
NYDD4377Medicare ID - Type UnspecifiedUPSTATE