Provider Demographics
NPI:1467580753
Name:PETER L. MENGER, M.D., P.C.
Entity Type:Organization
Organization Name:PETER L. MENGER, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:MENGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-386-1818
Mailing Address - Street 1:7809 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7439
Mailing Address - Country:US
Mailing Address - Phone:718-386-1818
Mailing Address - Fax:718-821-1852
Practice Address - Street 1:7809 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7439
Practice Address - Country:US
Practice Address - Phone:718-386-1818
Practice Address - Fax:718-821-1852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WEZ241Medicare PIN
NY23589Medicare PIN