Provider Demographics
NPI:1356459929
Name:KWON, PETER H (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:H
Last Name:KWON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:384 CRYSTAL RUN RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-4013
Mailing Address - Country:US
Mailing Address - Phone:845-692-8780
Mailing Address - Fax:845-692-3439
Practice Address - Street 1:384 CRYSTAL RUN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-4013
Practice Address - Country:US
Practice Address - Phone:845-692-8780
Practice Address - Fax:845-692-3439
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY216778174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist