Provider Demographics
NPI:1518952100
Name:CUTLER, PETER (DPM)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:CUTLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CARLETON AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752-2236
Mailing Address - Country:US
Mailing Address - Phone:631-581-8822
Mailing Address - Fax:631-581-0857
Practice Address - Street 1:111 CARLETON AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:ISLIP TERRACE
Practice Address - State:NY
Practice Address - Zip Code:11752-2236
Practice Address - Country:US
Practice Address - Phone:631-581-8822
Practice Address - Fax:631-581-0857
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002154213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP15421Medicare ID - Type Unspecified
NYT50648Medicare UPIN