Provider Demographics
NPI:1356329734
Name:SIROKA, PETER YALE (DPM)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:YALE
Last Name:SIROKA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5557
Mailing Address - Country:US
Mailing Address - Phone:203-327-9321
Mailing Address - Fax:800-432-0712
Practice Address - Street 1:1275 SUMMER ST STE 106
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5315
Practice Address - Country:US
Practice Address - Phone:203-614-8185
Practice Address - Fax:800-432-0712
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN-003988-1213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY17920Medicare ID - Type Unspecified
NYT92823Medicare UPIN
CT480000740Medicare ID - Type Unspecified
NYT92823Medicare UPIN
NY53226400001OtherMEDICARE DME