Provider Demographics
NPI:1407425515
Name:PECK, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:PECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 791
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-0791
Mailing Address - Country:US
Mailing Address - Phone:908-237-5420
Mailing Address - Fax:
Practice Address - Street 1:4660 KENMORE AVE STE 1100
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1311
Practice Address - Country:US
Practice Address - Phone:703-370-0073
Practice Address - Fax:703-370-2002
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant