Provider Demographics
NPI:1366450439
Name:PREVITE, PETER Z (DC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:Z
Last Name:PREVITE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 W THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-5007
Mailing Address - Country:US
Mailing Address - Phone:315-337-0300
Mailing Address - Fax:315-337-1601
Practice Address - Street 1:203 W THOMAS ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-5007
Practice Address - Country:US
Practice Address - Phone:315-337-0300
Practice Address - Fax:315-337-1601
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009099111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB2410Medicare ID - Type UnspecifiedMEEDICARE PROVIDER #