Provider Demographics
NPI:1568499051
Name:PETERSOHN, JEFFREY DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DAVID
Last Name:PETERSOHN
Suffix:
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 1:199 NEW RD
Mailing Address - Street 2:CENTRAL SQUARE SUITE 62-63
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1325
Mailing Address - Country:US
Mailing Address - Phone:609-926-3331
Mailing Address - Fax:609-926-3350
Practice Address - Street 1:199 NEW RD
Practice Address - Street 2:CENTRAL SQUARE SUITE 62-63
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1325
Practice Address - Country:US
Practice Address - Phone:609-926-3331
Practice Address - Fax:609-926-3350
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05788100207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJB59016Medicare UPIN
NJ728464C81Medicare ID - Type UnspecifiedINDIVIDUAL