Provider Demographics
NPI:1346299500
Name:SULTAN, PETER G (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:G
Last Name:SULTAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 MAIN RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-1953
Mailing Address - Country:US
Mailing Address - Phone:631-727-6308
Mailing Address - Fax:631-369-8129
Practice Address - Street 1:31 MAIN RD
Practice Address - Street 2:SUITE 3
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-1953
Practice Address - Country:US
Practice Address - Phone:631-727-6308
Practice Address - Fax:631-369-8129
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228415207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
531F31Medicare ID - Type Unspecified
H61665Medicare UPIN