Provider Demographics
NPI:1437319274
Name:REILLY, PETER (NP)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:REILLY
Suffix:
Gender:M
Credentials:NP
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:STONY BROOK UNIVERSITY HOSPITAL
Mailing Address - Street 2:12 NORTH ROOM 048
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794
Mailing Address - Country:US
Mailing Address - Phone:631-444-8090
Mailing Address - Fax:631-444-8850
Practice Address - Street 1:STONY BROOK UNIVERSITY HOSPITAL
Practice Address - Street 2:12 NORTH ROOM 048
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794
Practice Address - Country:US
Practice Address - Phone:631-444-8090
Practice Address - Fax:631-444-8850
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2016-06-02
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Provider Licenses
StateLicense IDTaxonomies
NY332379363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily