Provider Demographics
NPI:1538323175
Name:PEET, JON (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:PEET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 WOODBOURNE RD STE 303
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19057-1521
Mailing Address - Country:US
Mailing Address - Phone:215-547-1818
Mailing Address - Fax:
Practice Address - Street 1:1609 WOODBOURNE RD STE 303
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19057-1521
Practice Address - Country:US
Practice Address - Phone:215-547-1818
Practice Address - Fax:215-547-5174
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09005100207W00000X
PAMD443573207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102664844Medicaid
PA073401Medicare PIN