Provider Demographics
NPI:1528029139
Name:MARIS, PETER JG JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JG
Last Name:MARIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1138
Mailing Address - Country:US
Mailing Address - Phone:516-872-8309
Mailing Address - Fax:516-872-8727
Practice Address - Street 1:230 HILTON AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-8115
Practice Address - Country:US
Practice Address - Phone:516-481-1786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219623207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0511B61Medicare ID - Type Unspecified
NYI06070Medicare UPIN