Provider Demographics
NPI:1437472529
Name:ROY, PETER G (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:G
Last Name:ROY
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 1:1060 ROUTE 9W S
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-4906
Mailing Address - Country:US
Mailing Address - Phone:845-558-0917
Mailing Address - Fax:
Practice Address - Street 1:1060 ROUTE 9W S
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-4906
Practice Address - Country:US
Practice Address - Phone:845-558-0917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006287111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU40974Medicare UPIN