Provider Demographics
NPI:1336502889
Name:KERI PETERSON MD PC
Entity Type:Organization
Organization Name:KERI PETERSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KERI
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-429-9954
Mailing Address - Street 1:115 E 57TH ST
Mailing Address - Street 2:SUITE 510
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2049
Mailing Address - Country:US
Mailing Address - Phone:212-583-2962
Mailing Address - Fax:212-744-4072
Practice Address - Street 1:115 E 57TH ST
Practice Address - Street 2:SUITE 510
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2049
Practice Address - Country:US
Practice Address - Phone:212-583-2962
Practice Address - Fax:212-744-4072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty