Provider Demographics
NPI:1578612727
Name:LOTFI, PETER B (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:B
Last Name:LOTFI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BOUTROS
Other - Middle Name:
Other - Last Name:LOTFI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 BROADWAY
Mailing Address - Street 2:2NDFLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-1901
Mailing Address - Country:US
Mailing Address - Phone:212-263-9700
Mailing Address - Fax:212-263-9701
Practice Address - Street 1:111 BROADWAY
Practice Address - Street 2:2NDFLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-1901
Practice Address - Country:US
Practice Address - Phone:212-263-9700
Practice Address - Fax:212-263-9701
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171553207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10E041Medicare ID - Type Unspecified
A60473Medicare UPIN